Optimal Perfusion Computed Tomographic Thresholds for Ischemic Core and Penumbra Are Not Time Dependent in the Clinically Relevant Time Window
Optimal Perfusion Computed Tomographic Thresholds for Ischemic Core and Penumbra Are Not Time Dependent in the Clinically Relevant Time Window
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DOI：
10.1161/strokeaha.113.003362
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发表时间：
2014-05-01
期刊：
影响因子：
8.3
通讯作者：
Wintermark, Max
中科院分区：
文献类型：
--
作者：
Qiao, Yujie;Zhu, Guangming;Wintermark, Max
背景和目的本研究旨在确定在出现急性卒中症状的患者中描绘缺血核心区和半影区的灌注计算机断层扫描 (PCT) 阈值是时间依赖性的还是时间独立的。方法在一项回顾性多中心研究中对 217 名患者进行了评估。患者被分为持续性闭塞患者和再通患者。所有患者均接受入院 PCT 和随访成像以确定最终的缺血核心，然后将其与 PCT 图像进行回顾性匹配，以确定不同 PCT 参数的最佳阈值。评估这些阈值自症状出现以来随时间的显着变化。结果在持续闭塞组中，不随时间显着变化的最佳 PCT 参数包括绝对平均通过时间、相对平均通过时间、相对脑血流量和症状出现后 15 小时内的相对脑血量。相反，再通组在任何时间间隔内的任何 PCT 参数都没有表现出显着的时间变化。在持续闭塞组中，描绘总缺血区域的最佳阈值是阈值 180% 的相对平均通过时间。在再通患者中，预测缺血核心的最佳参数是相对脑血容量，阈值为66%。结论对于相对平均通过时间和相对脑血容量，时间不影响症状出现后15小时内描绘缺血核心和半暗带的最佳PCT阈值，这是描绘缺血核心和半暗带的最佳参数。
Background and Purpose This study aims to determine whether perfusion computed tomographic (PCT) thresholds for delineating the ischemic core and penumbra are time dependent or time independent in patients presenting with symptoms of acute stroke.Methods Two hundred seventeen patients were evaluated in a retrospective, multicenter study. Patients were divided into those with either persistent occlusion or recanalization. All patients received admission PCT and follow-up imaging to determine the final ischemic core, which was then retrospectively matched to the PCT images to identify optimal thresholds for the different PCT parameters. These thresholds were assessed for significant variation over time since symptom onset.Results In the persistent occlusion group, optimal PCT parameters that did not significantly change with time included absolute mean transit time, relative mean transit time, relative cerebral blood flow, and relative cerebral blood volume when time was restricted to 15 hours after symptom onset. Conversely, the recanalization group showed no significant time variation for any PCT parameter at any time interval. In the persistent occlusion group, the optimal threshold to delineate the total ischemic area was the relative mean transit time at a threshold of 180%. In patients with recanalization, the optimal parameter to predict the ischemic core was relative cerebral blood volume at a threshold of 66%.Conclusions Time does not influence the optimal PCT thresholds to delineate the ischemic core and penumbra in the first 15 hours after symptom onset for relative mean transit time and relative cerebral blood volume, the optimal parameters to delineate ischemic core and penumbra.