The ischemic penumbra -: Operationally defined by diffusion and perfusion MRI
The ischemic penumbra -: Operationally defined by diffusion and perfusion MRI
复制标题
DOI：
10.1212/wnl.53.7.1528
复制
发表时间：
1999-10-22
期刊：
影响因子：
9.9
通讯作者：
Warach, S
中科院分区：
文献类型：
--
作者：
Schlaug, G;Benfield, A;Warach, S
背景：识别有梗塞风险的组织对于决定哪些患者将从潜在的有害疗法中受益最多，并提供了一种评估新疗法的方法，以评估所取消的缺血性组织量。目的：在操作上定义和表征有中风进展风险的脑组织。方法：我们回顾性地从数据库中急性发作的半球中风急性发作，他们的数据库进行了两种扩散加权MRI研究和一项灌注加权MRI研究的组合。我们使用相对平均转运时间和相对脑血流（RCBF）的地图以及相对脑血体积（RCBV）的三个不同的地图应用了逻辑回归模型，以预测在操作上定义的PENUMBRA（扩散区域之间的不匹配区域第1天的病变及其延伸24至72小时后）。结果：RCBF和初始RCBV的地图是鉴定半月组织的重要预测指标。我们的操作定义的半月区域的特征是最初的RCBV（占对对照区域的47％[CCR]）的降低，总RCBV的增加（占CCR的163％），而在CCR中的降低（占CCR的163％），CCR的降低（占CCR的37％）（占CCR的37％） RCBF，而操作定义的缺血核显示RCBF（占CCR的12％）和最初的RCBV（占CCR的19％）的降低更为严重。结论：这些MR索引可以允许在中风患者的超急性护理中鉴定和量化可行但受到威胁性的脑组织。
Background: Identifying tissue at risk for infarction is important in deciding which patients would benefit most from potentially harmful therapies and provides a way to evaluate newer therapies with regard to the amount of ischemic tissue salvaged. Objective: To operationally define and characterize cerebral tissue at risk for stroke progression. Methods: We retrospectively selected 25 patients with an acute onset of a hemispheric stroke from our database who had undergone a combination of two diffusion-weighted MRI studies and a perfusion-weighted MRI study. We applied a logistic regression model using maps of the relative mean transit time and relative cerebral blood flow (rCBF) as well as three different maps of the relative cerebral blood volume (rCBV) to predict an operationally defined penumbra (region of mismatch between the diffusion lesion on day 1 and its extension 24 to 72 hours later). Results: Maps of the rCBF and initial rCBV were significant predictors for identifying penumbral tissue. Our operationally defined penumbral region was characterized by a reduction in the initial rCBV (47% of contralateral control region [CCR]), an increase (163% of CCR) in the total rCBV, and a reduction (37% of CCR) in the rCBF, whereas the operationally defined ischemic core showed a more severe reduction in the rCBF (12% of CCR) and in the initial rCBV (19% of CCR). Conclusion: These MR indexes may allow the identification and quantification of viable but ischemically threatened cerebral tissue amenable to therapeutic interventions in the hyperacute care of stroke patients.