Imaging for prediction of functional outcome and assessment of recovery in ischemic stroke.
Imaging for prediction of functional outcome and assessment of recovery in ischemic stroke.
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DOI：
10.1161/strokeaha.113.003611
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发表时间：
2014-04
期刊：
影响因子：
8.3
通讯作者：
Kidwell CS
中科院分区：
文献类型：
--
作者：
Heiss WD;Kidwell CS
高分辨率结构磁共振成像（MRI）序列可重复识别即使是很小的中风病变，但将病变的大小与临床损伤和功能结果联系起来是困难的，特别是因为皮质下白质或脑干的小病变可产生不成比例的临床障碍。缺血性损伤累及皮质脊髓束是限制运动恢复的一个特别重要的因素。21严重的白质疾病也可能是功能预后不良的独立预测因子。22弥散加权成像（DWI）提供了一种早期、清晰、敏感的测量缺血性脑病变的大小和位置的方法。DWI对组织内水分子的运动很敏感，在早期缺血时细胞毒性水肿区域水分子运动减少。在前循环非腔隙性卒中患者中，除年龄和NIHSS评分外，DWI评估的病变体积是预后的独立预测因子，将最终Barthel指数高于或低于85的患者分开。23种DWI病变体积预测模型的功率有部分显著增加，但不是全部；然而，在另一项分析中，这种影响不足以在临床上具有重要意义。在轻度至中度缺血性卒中后的前5天内，随着DWI梗死体积的增加，获得良好神经学预后的可能性大大降低。一些研究结合了梗塞位置的信息来预测神经功能缺损。27日、28日
High resolution structural magnetic resonance imaging (MRI) sequences reproducibly identify even small stroke lesions, but relating the size of lesions to clinical impairment and functional outcome is difficult especially because small lesions of the subcortical white matter or the brain stem can produce disproportionate clinical disturbances. 20 Involvement of the corticospinal tract by the ischemic lesion is a particularly important factor limiting motor recovery. 21 Severe white matter disease may also be an independent predictor of poor functional outcome. 22Diffusion-weighted imaging (DWI) provides an early, distinct, and sensitive measure of both the size and location of ischemic brain lesions. DWI is sensitive to the movement of water molecules within the tissue, which is reduced in regions of cytotoxic edema during early ischemia. In patients with nonlacunar strokes in the anterior circulation, lesion volume assessed by DWI in addition to age and NIHSS score was an independent predictor of outcome, separating patients with a final Barthel Index above or below 85. 23 DWI lesion volume significantly increased power of some, but not all, 24 prediction models; however, this effect was not large enough to be clinically important in another analysis. 25 The likelihood of achieving excellent neurological outcome diminished substantially with growth in DWI infarct volume in the first 5 days after ischemic stroke of mild to moderate severity. 26 Some studies have incorporated information on infarct location to predict neurological deficits. 27, 28