Pretreatment blood-brain barrier damage and post-treatment intracranial hemorrhage in patients receiving intravenous tissue-type plasminogen activator.
Pretreatment blood-brain barrier damage and post-treatment intracranial hemorrhage in patients receiving intravenous tissue-type plasminogen activator.
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DOI：
10.1161/strokeaha.114.005249
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发表时间：
2014-07
期刊：
影响因子：
8.3
通讯作者：
STIR and VISTA Imaging Investigators
中科院分区：
文献类型：
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作者：
Leigh R;Jen SS;Hillis AE;Krakauer JW;Barker PB;STIR and VISTA Imaging Investigators
急性缺血性卒中（AIS）后早期血脑屏障（BBB）损伤与随后的颅内出血（ICH）有定性联系。在这项定量研究中，我们探讨了在tpa前MRI扫描中明显的血脑屏障损伤量是否与AIS患者tpa后脑出血的程度有关。对STIR和VISTA影像学研究人员提供的AIS患者数据库进行分析。包括静脉tPA前灌注加权成像（PWI）病变bbb10ml和梯度回忆回声（GRE）阴性的患者。对PWI源图像进行后处理，以估计灌注缺陷内血脑屏障通透性相对于未受影响的半球的变化。回顾随访的GRE图像以寻找脑出血的证据，并根据ECASS标准分为三组：无出血（NH）、出血性梗死（HI）和实质血肿（PH）。数据库中有75例患者符合纳入标准，其中28例为ICH，其中19例为HI， 9例为PH。平均渗透率（±标准差），以造影剂渗漏指数表示，NH组为17.0%±8.8，HI组为19.4%±4.0，PH组为24.6%±4.5。在单因素（p=0.007）和多因素（p=0.008）线性回归模型中，通透性与ICH分级显著相关。静脉tPA前测量的pwi衍生的血脑屏障损伤指数与AIS患者治疗后脑出血的严重程度相关。
Early blood brain barrier (BBB) damage after acute ischemic stroke (AIS) has previously been qualitatively linked to subsequent intracranial hemorrhage (ICH). In this quantitative study, it was investigated whether the amount of BBB damage evident on pre-tPA MRI scans was related to the degree of post-tPA ICH in patients with AIS. Analysis was performed on a database of patients with AIS provided by the STIR and VISTA Imaging Investigators. Patients with perfusion-weighted imaging (PWI) lesions >10mL and negative gradient-recalled echo (GRE) imaging prior to IV tPA were included. Post processing of the PWI source images was performed to estimate changes in BBB permeability within the perfusion deficit relative to the unaffected hemisphere. Follow-up GRE images were reviewed for evidence of ICH and divided into three groups according to ECASS criteria: no hemorrhage (NH), hemorrhagic infarction (HI), and parenchymal hematoma (PH). 75 patients from the database met the inclusion criteria, 28 of whom experienced ICH, of which 19 were classified as HI, and nine were classified as PH. The mean permeability (±standard deviations), expressed as an index of contrast leakage, was 17.0%±8.8 in the NH group, 19.4%±4.0 in the HI group, and 24.6%±4.5 in the PH group. Permeability was significantly correlated with ICH grade in univariate (p=0.007) and multivariate (p=0.008) linear regression modeling. A PWI-derived index of BBB damage measured prior to IV tPA is associated with the severity of ICH after treatment in patients with AIS.