Reperfusion after severe local perfusion deficit precedes hemorrhagic transformation:: An MRI study in acute stroke patients
Reperfusion after severe local perfusion deficit precedes hemorrhagic transformation:: An MRI study in acute stroke patients
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DOI：
10.1159/000083180
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发表时间：
2005-01-01
影响因子：
2.9
通讯作者：
Röther, J
中科院分区：
文献类型：
--
作者：
Fiehler, J;Remmele, C;Röther, J
背景资料：我们应用磁共振成像来分析局部扩散和灌注异常的程度以及随后出血性转化（HT）区域的再灌注状态。研究方法：51例急性缺血性卒中患者在第1天和第5 - 8天在3.0 +/- 0.8小时内通过弥散和灌注加权成像进行了研究。重新排列图像数据集后，分析随后HT区域的表观弥散系数（ADC）、脑血流量（CBF）和脑血容量（CBV）以及平均通过时间的参数图。将HT区局部弥散和灌注损害的程度与整个弥散和灌注异常进行比较。分别评估整个灌注异常和HT区域的再灌注状态。结果：51例患者中有19例（37.2%）在发病后8天内观察到HT。与整个灌注异常相比，HT区域的ADC（至70 +/- 13%; p < 0.01）、CBV（至31 +/- 26%; p < 0.001）和CBF（至28 +/- 19%; p < 0.001）下降更严重。18/19例患者HT区局部再灌注。HT的存在与更差的临床结局不一致。讨论内容：HT是局部灌注损伤最严重的区域再灌注的结果，不影响神经学结局。版权所有（C）2005 S. Karger AG，巴塞尔
Background: We applied magnetic resonance imaging to analyze the degree of local diffusion and perfusion abnormalities and the status of reperfusion in regions with subsequent hemorrhagic transformation ( HT). Methods: 51 patients with acute ischemic stroke were studied by diffusion- and perfusion-weighted imaging within 3.0 +/- 0.8 h, on day 1 and days 5 - 8. After realignment of the image data sets, the parameter maps of the apparent diffusion coefficient ( ADC), cerebral blood flow ( CBF) and cerebral blood volume ( CBV), and mean transit time were analyzed in the area of subsequent HT. The degree of local diffusion and perfusion impairment in the HT area was compared with the entire diffusion and perfusion abnormality. Reperfusion status was separately assessed for the entire perfusion abnormality and the HT area. Results: HT was observed in 19/51 patients (37.2%) within 8 days after symptom onset. Areas destined for HT revealed a more severe decrease in ADC ( to 70 +/- 13%; p < 0.01), CBV ( to 31 +/- 26%; p < 0.001) and CBF (to 28 +/- 19%; p < 0.001) compared to the entire perfusion abnormality. Local reperfusion in the HT area was seen in 18/19 patients. The presence of HT did not coincide with a worse clinical outcome. Discussion: HT is the result of reperfusion in the region with the most severe local perfusion impairment and does not influence the neurological outcome. Copyright (C) 2005 S. Karger AG, Basel