Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study
Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study
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DOI：
10.1136/jnnp-2013-307313
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发表时间：
2015-01-01
影响因子：
11
通讯作者：
Gordon, Errol
中科院分区：
文献类型：
--
作者：
Frontera, Jennifer A.;Ahmed, Wamda;Gordon, Errol
目的 确定缺血是否是蛛网膜下腔出血（SAH）动脉瘤破裂时早期脑损伤的一种机制，以及早期磁共振成像（MRI）显示的缺血是否与入院临床状态和功能预后相关。
方法 在一项前瞻性、假设驱动的研究中，SAH患者在发病0 - 3天内（血管痉挛之前）接受MRI检查，并在（中位数为7天）再次接受MRI检查。对急性MRI上扩散加权成像（DWI）阳性/表观扩散系数（ADC）低信号病变的体积和数量进行定量评估。分析早期缺血、入院临床状态、危险因素与3个月预后之间的关联。
结果 在61例SAH患者中，共进行了131次MRI检查。40例（66%）患者出现早期缺血，平均DWI/ADC体积为8.6 mL（0 - 198 mL），病变数量为4.3个（0 - 25个）。任何早期DWI/ADC病变的存在以及病变体积的增加都与更差的亨特 - 黑斯（Hunt - Hess）分级、格拉斯哥昏迷量表评分以及急性生理与慢性健康评估II的生理子评分相关（所有P值<0.05）。（最后一个单词“p”可能是文档截取不全，推测后面应该是小于某个值的表述）
Objective To determine if ischaemia is a mechanism of early brain injury at the time of aneurysm rupture in subarachnoid haemorrhage (SAH) and if early MRI ischaemia correlates with admission clinical status and functional outcome.Methods In a prospective, hypothesis-driven study patients with SAH underwent MRI within 0-3 days of ictus (prior to vasospasm) and a repeat MRI (median 7 days). The volume and number of diffusion weighted imaging (DWI) positive/apparent diffusion coefficient (ADC) dark lesions on acute MRI were quantitatively assessed. The association of early ischaemia, admission clinical status, risk factors and 3-month outcome were analysed.Results In 61 patients with SAH, 131 MRI were performed. Early ischaemia occurred in 40 (66%) with a mean DWI/ADC volume 8.6 mL (0-198 mL) and lesion number 4.3 (0-25). The presence of any early DWI/ADC lesion and increasing lesion volume were associated with worse Hunt-Hess grade, Glasgow Coma Scale score and Acute Physiology and Chronic Health Evaluation II physiological subscores (all p