Multiparametric MRI and CT models of infarct core and favorable penumbral imaging patterns in acute ischemic stroke.
Multiparametric MRI and CT models of infarct core and favorable penumbral imaging patterns in acute ischemic stroke.
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DOI：
10.1161/strokeaha.112.670034
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发表时间：
2013-01
期刊：
影响因子：
8.3
通讯作者：
Saver JL
中科院分区：
文献类型：
--
作者：
Kidwell CS;Wintermark M;De Silva DA;Schaewe TJ;Jahan R;Starkman S;Jovin T;Hom J;Jumaa M;Schreier J;Gornbein J;Liebeskind DS;Alger JR;Saver JL
需要客观的成像方法来确定晚期再通治疗的最佳候选者。研究目标是：1）开发急性缺血性卒中患者梗死核心和半暗带的MRI和CT多参数、基于体素的预测模型; 2）基于成功再通的良好临床结局，开发有利半暗带模式的患者水平成像标准。对成功治疗大血管、前循环卒中的两组患者（一组接受CT筛查，另一组接受MRI筛查）进行了影像学和临床数据分析。受试者以2：1的比例分为推导和验证队列。治疗前的成像参数独立预测最终的组织梗死和最终的临床结果进行了鉴定。MRI和CT模型分别由34名和32名患者开发和验证，分别采用943，320和1，236，917体素。衍生MRI和双分支CT模型的总体准确度分别为74%和80%，并分别以71%和79%的准确度进行独立验证。1）预测梗死核心≤ 90 mL和2）风险区域内预测梗死组织的比率≤ 70%的成像标准将患者确定为具有良好的半影模式，准确度为78-100%。开发了基于多参数体素的MRI和CT模型，以预测急性缺血性卒中患者的梗死核心范围和总体半影模式状态，这些患者可能是晚期再通治疗的候选者。这些模型为预测最终组织命运提供了一种替代方法。
Objective imaging methods to identify optimal candidates for late recanalization therapies are needed. The study goals were 1) to develop MRI and CT multiparametric, voxel-based predictive models of infarct core and penumbra in acute ischemic stroke patients, and 2) to develop patient-level imaging criteria for favorable penumbral pattern based on good clinical outcome in response to successful recanalization. An analysis of imaging and clinical data was performed on two cohorts of patients (one screened with CT, the other with MRI) who underwent successful treatment for large vessel, anterior circulation stroke. Subjects were divided 2:1 into derivation and validation cohorts. Pretreatment imaging parameters independently predicting final tissue infarct and final clinical outcome were identified. The MRI and CT models were developed and validated from 34 and 32 patients, employing 943,320 and 1,236,917 voxels respectively. The derivation MRI and two-branch CT models had an overall accuracy of 74% and 80% respectively, and were independently validated with an accuracy of 71% and 79% respectively. The imaging criteria of 1) predicted infarct core ≤ 90 mL and 2) ratio of predicted infarct tissue within the at-risk region ≤ 70% identified patients as having a favorable penumbral pattern with 78–100% accuracy. Multiparametric voxel-based MRI and CT models were developed to predict the extent of infarct core and overall penumbral pattern status in patients with acute ischemic stroke who may be candidates for late recanalization therapies. These models provide an alternative approach to mismatch in predicting ultimate tissue fate.