Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis
Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis
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DOI：
10.1007/s00234-006-0105-0
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发表时间：
2006-09-01
期刊：
影响因子：
2.8
通讯作者：
Kanovsky, Petr
中科院分区：
文献类型：
--
作者：
Sanak, Daniel;Nosal', Vladimir;Kanovsky, Petr
简介：磁共振成像 (MRI) 可能有助于识别急性中风患者，从溶栓治疗中获得更高的潜在益处。我们研究的目的是评估通过静脉/动脉内溶栓治疗的 MRI 血管造影检测到大脑中动脉 (MCA)（M1-2 段）闭塞的急性卒中患者的初始脑梗塞 (CI) 体积（通过弥散加权 MRI 量化）与由此产生的临床结果之间的相关性。方法：回顾性比较初始梗塞体积 (VDWI-I) 与入院时和 24 小时后使用 NIH 卒中量表评估的神经功能缺损，以及使用改良 Rankin 量表评估的 25 名连续 CI 患者的 90 天临床结果。评估梗塞体积和神经功能缺损严重程度之间的关系，并在确定仍与良好临床结果相关的最大 VDWI-I 后，将患者分为两组（VDWI-I 70 ml）。结果：VDWI-I 范围为 0.7 至 321 ml。 87% 的 VDWI-I 70 ml 患者（第 2 组）的 24 小时临床结果显着改善（P=0.0001）。第1组的90天死亡率为0%，第2组的90天死亡率为71.5%。第1组的90天临床结果明显优于第2组（P=0.026）。结论：对于接受静脉/动脉内溶栓治疗的 MCA 闭塞的急性 CI 患者，可以通过 MRI-DWI 量化的初始梗塞体积来预测临床结果。 VDWI-I >= 70 ml 的患者预后明显更好。
Introduction: Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M1-2 segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis. Methods: Initial infarct volume (VDWI-I ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum VDWI-I still associated with a good clinical outcome, the patients were divided into two groups (VDWI-I 70 ml). Results: VDWI-I ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a VDWI-I 70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026). Conclusion: Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a VDWI-I >= 70 ml had a significantly better outcome.