Pretreatment diffusion-and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis
Pretreatment diffusion-and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis
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DOI：
10.1038/jcbfm.2010.3
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发表时间：
2010-06-01
影响因子：
6.3
通讯作者：
Davis, Stephen M.
中科院分区：
文献类型：
--
作者：
Parsons, Mark W.;Christensen, Soren;Davis, Stephen M.
假设在超声平面成像溶栓评估试验（EPITHET）中，预处理磁共振成像（MRI）弥散加权成像（DWI）和灌注加权成像（PWI）病变体积可能会影响溶栓的临床反应。在中风发作后3至6小时，98名患者随机接受静脉注射（IV）组织型纤溶酶原激活剂（tPA）或安慰剂治疗，我们检查了急性DWI和PWI病变体积（tmax - 2秒延迟增量）的增加，以及PWI/DWI失配比的增加，以及临床结果优秀（改良Rankin量表（mRS）： 0至1）和差（mRS: 5至6）的几率。非常大的PWI病变（大多数有颈内动脉闭塞）患者IV-tPA的不良结果的优势比（OR）增加（58% vs 25%安慰剂；OR = 4.13， Tmax +2秒容量> 190 mL）。在DWI病变< 18mL的患者中，tPA治疗的良好结果显著增加（77% vs 18%安慰剂，OR = 15.0, P < 0.001）。DWI病变高达25mL时，tPA也有益处（69% vs 29%安慰剂组，OR = 5.5, P = 0.03），但DWI病变小于25mL时，tPA没有益处。相反，不匹配比例的增加并不影响tPA获得良好结果的几率。临床对IV-tPA的反应性和卒中结局更多地取决于基线DWI和PWI病变体积，而不是灌注-扩散不匹配的程度。脑血流与代谢杂志（2010）30,1214-1225；doi: 10.1038 / jcbfm.2010.3;2010年1月20日在线发布
hypothesized that pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) lesion volumes may have influenced clinical response to thrombolysis in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). In 98 patients randomized to intravenous (IV) tissue plasminogen activator (tPA) or placebo 3 to 6 h after stroke onset, we examined increasing acute DWI and PWI lesion volumes (Tmax-with 2-sec delay increments), and increasing PWI/DWI mismatch ratios, on the odds of both excellent (modified Rankin Scale (mRS): 0 to 1) and poor (mRS: 5 to 6) clinical outcome. Patients with very large PWI lesions (most had internal carotid artery occlusion) had increased odds ratio (OR) of poor outcome with IV-tPA (58% versus 25% placebo; OR = 4.13, P = 0.032 for Tmax +2-sec volume > 190 mL). Excellent outcome from tPA treatment was substantially increased in patients with DWI lesions < 18mL (77% versus 18% placebo, OR = 15.0, P < 0.001). Benefit from tPA was also seen with DWI lesions up to 25mL (69% versus 29% placebo, OR = 5.5, P = 0.03), but not for DWI lesions > 25 mL. In contrast, increasing mismatch ratios did not influence the odds of excellent outcome with tPA. Clinical responsiveness to IV-tPA, and stroke outcome, depends more on baseline DWI and PWI lesion volumes than the extent of perfusion-diffusion mismatch. Journal of Cerebral Blood Flow & Metabolism (2010) 30, 1214-1225; doi: 10.1038/jcbfm.2010.3; published online 20 January 2010