Multivariate dynamic prediction of ischemic infarction and tissue salvage as a function of time and degree of recanalization
Multivariate dynamic prediction of ischemic infarction and tissue salvage as a function of time and degree of recanalization
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DOI：
10.1038/jcbfm.2015.144
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发表时间：
2015-09-01
影响因子：
6.3
通讯作者：
Fiehler, Jens
中科院分区：
文献类型：
--
作者：
Kemmling, Andre;Flottmann, Fabian;Fiehler, Jens
超过既定治疗时间窗的血管内再通的好处可能存在于选定的中风患者中。然而，目前还没有一个成像模型可以预测从入院时的病理快照到血管内再通之间经过的时间来调整脑梗塞。我们训练并交叉验证了多变量广义线性模型(GLM)，该模型使用计算机断层扫描、血流灌注和临床数据来量化取决于再通程度和时间的特定于患者的组织梗塞的动态变化。纳入161例接受血管内治疗的近端前循环闭塞患者的多中心资料。在GLM内计算多变量体素心肌梗死概率。在每个患者中计算延长治疗时间和再通程度对体位性脑梗塞的影响。在个别患者中，成功的血管再通相对于不成功的血管再通的组织益处在发病后15小时内显示出来，并且随着时间的推移呈非线性下降。平均而言，在治疗间隔5小时时，脑梗塞体积的相对缩小为53%，而治疗后10小时，这种挽救效应每小时减少5%至5%。根据血流灌注和临床状态对脑梗塞的治疗时间进行调整后的多变量预测可以确定哪些患者受益于延长再通治疗的时间。
Benefit of endovascular recanalization beyond established treatment time windows likely exists in select stroke patients. However, there is currently no imaging model that predicts infarction adjusting for elapsed time between the pathologic snapshot of admission imaging until endovascular recanalization. We trained and cross validated a multivariate generalized linear model (GLM) that uses computer tomography perfusion and clinical data to quantify patient-specific dynamic change of tissue infarction depending on degree and time of recanalization. Multicenter data of 161 patients with proximal anterior circulation occlusion undergoing endovascular therapy were included. Multivariate voxelwise infarct probability was calculated within the GLM. The effect of increasing time to treatment and degree of recanalization on voxelwise infarction was calculated in each patient. Tissue benefit of successful relative to unsuccessful recanalization was shown up to 15 hours after onset in individual patients and decreased nonlinearly with time. On average, the relative reduction of infarct volume at the treatment interval of 5 hours was 53% and this salvage effect decreased by 5% units per hour to < 5% after 10 additional hours to treatment. Treatment time-adjusted multivariate prediction of infarction by perfusion and clinical status may identify patients who benefit from extended time to recanalization therapy.