Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging.
Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging.
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作者：
灌注加权成像(PWI)对于确定出现较长时间窗的中风患者是否适合进行机械血栓切除术至关重要。然而，PWI并不总是可用的。PWI病变患者可见FLAIR高信号血管(FHV)。我们调查了衡量FHV范围的量表是否可以作为PWI的替代指标来确定是否有资格接受血栓切除。NIH-FHV评分被用来量化FHV的负担，并应用于FLAIR和灌注成像的中风患者的MRI扫描。将NIH-FHV与弥散加权成像(DWI)体积相结合，估计弥散-灌注失配率。用线性回归方法比较PWI体积和错配率与NIH-FHV评分的估计值。受试者操作员特征(ROC)分析用于测试NIH-FHV评分识别显著不匹配的能力。有101名患者纳入分析，其中78%的患者在PWI上检测到血流灌注不足，平均病变体积为47(±59)毫升。NIH-FHV评分与PWI病灶体积显著相关(P<；0.001，R平方=0.32，β系数=0.57)。当结合弥散加权成像病变体积时，ROC分析测试了使用≥-FHV评分检测失配率AUC1.8的能力，结果AUC0.94。NIH-FHV评分提供了PWI病变体积的估计，当与DWI结合使用时，可能有助于在无法进行灌注成像的情况下确定是否存在临床相关的扩散-灌注不匹配。需要进一步的研究来验证这一方法。
Perfusion weighted imaging (PWI) is critical for determining if stroke patients presenting in an extended time window are candidates for mechanical thrombectomy. However, PWI is not always available. FLAIR hyperintense vessels (FHV) are seen in patients with a PWI lesion. We investigated whether a scale measuring the extent FHV could serve as a surrogate for PWI to determine eligibility for thrombectomy. The NIH-FHV score was developed to quantify the burden of FHV and applied to MRI scans of stroke patients with FLAIR and perfusion imaging. The NIH-FHV was combined with the diffusion weighted image (DWI) volume to estimate the diffusion-perfusion mismatch ratio. Linear regression was used to compare PWI volumes and mismatch ratios with estimates from the NIH-FHV score. Receiver operator characteristic (ROC) analysis was used to test the ability of the NIH-FHV score to identify a significant mismatch. There were 101 patients included in the analysis, of whom 78% had a perfusion deficit detected on PWI with a mean lesion volume of 47 (±59) mL. The NIH-FHV score was strongly associated with the PWI lesion volume (p<0.001, R-squared=0.32, beta coefficient=0.57). When combined with DWI lesion volume, ROC analysis testing the ability to detect a mismatch ratio ≥ 1.8 using the NIH-FHV score resulted in an AUC of 0.94. The NIH-FHV score provides an estimate of the PWI lesion volume and, when combined with DWI, may be helpful when trying to determine if there is a clinically relevant diffusion-perfusion mismatch in situations where perfusion imaging is not available. Further studies are needed to validate this approach.
影响因子：
3.4
作者：
Grosch AS;Kufner A;Boutitie F;Cheng B;Ebinger M;Endres M;Fiebach JB;Fiehler J;Königsberg A;Lemmens R;Muir KW;Nighoghossian N;Pedraza S;Siemonsen CZ;Thijs V;Wouters A;Gerloff C;Thomalla G;Galinovic I
通讯作者：
Galinovic I