The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent
The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent
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DOI：
10.1038/jcbfm.2011.102
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发表时间：
2012-01-01
影响因子：
6.3
通讯作者：
Davis, Stephen M.
中科院分区：
文献类型：
--
作者：
Campbell, Bruce C. V.;Purushotham, Archana;Davis, Stephen M.
弥散加权成像(DWI)通常用于评估不可逆梗死组织，但其准确性受到扩散病变逆转(DLR)的报道的挑战。我们利用EPERHET(回声平面成像溶栓试验)和FUSE(弥散和灌注成像评价以了解卒中演变)研究中的成像，研究了DLR不匹配分类的频率和意义。在119名患者(83名接受静脉注射组织纤溶酶原激活剂)中，将随访图像与急性扩散图像进行配准，并在扩散空间中手动勾画病变的最大视觉范围。弥漫性病变逆转被定义为急性弥漫性病变的体素，在随访时与正常脑组织相对应(即最终的脑梗塞、脑白质疏松和脑脊液体素被排除在外)。肉眼检查DLR的外观是否有伪影，计算体积，并分析根据DLR体积调整基线扩散灶体积对灌注-扩散失配的影响。排除脑脊液/脑白质疏松后，DLR的中位数由4.4毫升降至1.5毫升。肉眼检查证实8/119(6.7%)为真DLR，中位数为2.33毫升。从急性弥散量中减去DLR改变了3/119(2.5%)患者的灌注-扩散失配(T-max；6秒，Ratio>；1.2)。弥漫性病变在基线和3-6小时DWI之间逆转的情况也不常见(7/65，11%)，而且通常是一过性的。临床上相关的DLR并不常见，也很少改变灌注-扩散失配。急性弥漫性病变通常是梗死灶的可靠信号。《脑血流与代谢杂志》(2012年)32期，50-56期；doi：10.1038/jcbfm.2011.102；2011年7月20日在线发表
Diffusion-weighted imaging (DWI) is commonly used to assess irreversibly infarcted tissue but its accuracy is challenged by reports of diffusion lesion reversal (DLR). We investigated the frequency and implications for mismatch classification of DLR using imaging from the EPITHET (Echoplanar Imaging Thrombolytic Evaluation Trial) and DEFUSE (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution) studies. In 119 patients (83 treated with IV tissue plasminogen activator), follow-up images were coregistered to acute diffusion images and the lesions manually outlined to their maximal visual extent in diffusion space. Diffusion lesion reversal was defined as voxels of acute diffusion lesion that corresponded to normal brain at follow-up (i.e., final infarct, leukoaraiosis, and cerebrospinal fluid (CSF) voxels were excluded from consideration). The appearance of DLR was visually checked for artifacts, the volume calculated, and the impact of adjusting baseline diffusion lesion volume for DLR volume on perfusion-diffusion mismatch analyzed. Median DLR volume reduced from 4.4 to 1.5mL after excluding CSF/leukoaraiosis. Visual inspection verified 8/119 (6.7%) with true DLR, median volume 2.33 mL. Subtracting DLR from acute diffusion volume altered perfusion-diffusion mismatch (T-max > 6 seconds, ratio > 1.2) in 3/119 (2.5%) patients. Diffusion lesion reversal between baseline and 3 to 6 hours DWI was also uncommon (7/65, 11%) and often transient. Clinically relevant DLR is uncommon and rarely alters perfusion-diffusion mismatch. The acute diffusion lesion is generally a reliable signature of the infarct core. Journal of Cerebral Blood Flow & Metabolism (2012) 32, 50-56; doi:10.1038/jcbfm.2011.102; published online 20 July 2011