Reversibility of Diffusion-Weighted Imaging Lesions in Patients With Ischemic Stroke in the WAKE-UP Trial
Reversibility of Diffusion-Weighted Imaging Lesions in Patients With Ischemic Stroke in the WAKE-UP Trial
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DOI：
10.1161/strokeaha.122.041505
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发表时间：
2023-06-01
期刊：
影响因子：
8.3
通讯作者：
Lemmens, Robin
中科院分区：
文献类型：
--
作者：
Scheldeman, Lauranne;Wouters, Anke;Lemmens, Robin
背景：弥散加权成像（DWI）病变的可逆性意味着并非所有DWI病变都代表永久性损伤组织。我们研究了DWI可逆性以及与WAKE-UP试验（基于磁共振成像的溶栓治疗唤醒卒中的有效性和安全性）患者的溶栓、再灌注和功能结局的相关性。方法：在这项对WAKE-UP的回顾性分析中，这是一项2012年9月至2017年6月在比利时、丹麦、法国、德国、西班牙和英国进行的随机对照试验（RCT），卷积神经网络在基线和随访（24小时）时对DWI病变（B=1000 s/mm（2））进行了分割。我们以两种方式计算绝对和相对DWI可逆性：第一，体积（基线体积-24小时体积>0），第二，基于体素（基线病变与24小时病变不重叠的部分）的方法。我们还定义了相对基于体素的DWI可逆性>50%，以解释配准不准确性。我们根据治疗组计算了可逆性的比值比，并在多变量模型中分析了可逆性与良好功能结局（改良兰金量表评分为0-1）的相关性。结果：在363例患者中，基线时的中位DWI体积为3（1-10）mL，随访时为6（2-20）mL。体积DWI可逆性为19%（69/363），中位绝对可逆体积为1 mL（0-2）或28%（14-50）。358/363例（99%）存在基于体素的DWI可逆性，中位绝对体积为1 mL（0-2），或相对为22%（9-38）。在18%的患者（67/363）中，存在基于体素的相对DWI可逆性>50%。阿替普酶治疗患者的体积DWI可逆性和基于体素的相对DWI可逆性>50%的发生率高于安慰剂治疗患者（OR分别为1.86 [95% CI，1.09-3.17]和2.03 [95% CI，1.18-3.50]）。基于体素的DWI相对可逆性>50%与良好的功能结局相关（OR，2.30 [95%CI，1.17-4.51]）。结论：在WAKE-UP试验中，大部分随机患者的DWI可逆性绝对体积较小。溶栓后可逆性更常见。
Background:Reversibility of the diffusion-weighted imaging (DWI) lesion means that not all of the DWI lesion represents permanently injured tissue. We investigated DWI reversibility and the association with thrombolysis, reperfusion and functional outcome in patients from the WAKE-UP trial (Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-Up Stroke). Methods:In this retrospective analysis of WAKE-UP, a randomized controlled trial (RCT) between September 2012 and June 2017 in Belgium, Denmark, France, Germany, Spain and United Kingdom, a convolutional neural network segmented the DWI lesions (b=1000 s/mm(2)) at baseline and follow-up (24 hours). We calculated absolute and relative DWI reversibility in 2 ways: first, a volumetric (baseline volume-24-hour volume >0) and second, a voxel-based (part of baseline lesion not overlapping with 24-hour lesion) approach. We additionally defined relative voxel-based DWI-reversibility >50% to account for coregistration inaccuracies. We calculated the odds ratio for reversibility according to treatment arm. We analyzed the association of reversibility with excellent functional outcome (modified Rankin Scale score of 0-1), in a multivariable model. Results:In 363 patients, the median DWI volume was 3 (1-10) mL at baseline and 6 (2-20) mL at follow-up. Volumetric DWI reversibility was present in 19% (69/363) with a median absolute reversible volume of 1 mL (0-2) or 28% (14-50) relatively. Voxel-based DWI reversibility was present in 358/363 (99%) with a median absolute volume of 1 mL (0-2), or 22% (9-38) relatively. In 18% of the patients (67/363), relative voxel-based DWI reversibility >50% was present. Volumetric DWI reversibility and relative voxel-based DWI reversibility >50% was more frequent in patients treated with alteplase versus placebo (OR, 1.86 [95% CI, 1.09-3.17] and OR, 2.03 [95% CI, 1.18-3.50], respectively). Relative voxel-based DWI reversibility >50% was associated with excellent functional outcome (OR, 2.30 [95% CI, 1.17-4.51]). Conclusions:Small absolute volumes of DWI reversibility were present in a large proportion of randomized patients in the WAKE-UP trial. Reversibility was more often present after thrombolysis.