Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status.
Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status.
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DOI：
10.5853/jos.2016.00955
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发表时间：
2017-01
影响因子：
8.2
通讯作者：
Bang OY
中科院分区：
文献类型：
--
作者：
Son JP;Lee MJ;Kim SJ;Chung JW;Cha J;Kim GM;Chung CS;Lee KH;Bang OY
已经对灌注-扩散不匹配进行了评价，以确定靶点不匹配的存在是否有助于识别对再通治疗反应良好的患者。我们使用磁共振灌注（MRP）技术比较了侧支循环状态和半暗带存在对梗死生长的影响。入选了适合再通治疗并接受了系列弥散加权成像（DWI）和MRP的连续患者。通过自动后处理，从MRP源数据中生成了一个抵押品流程图。采用多变量线性回归分析，比较靶点不匹配（Tmax>6 s/表观扩散系数（ADC）体积≥1.8，ADC体积<70 mL; ADC体积<100 mL时Tmax>10 s）对梗死生长的影响与第7天DWI上基于MR的侧支分级。在73例患者中，55例（75%）显示靶不匹配，而侧支循环不良14例（19.2%），中度36例（49.3%），良好23例（31.5%）。在校正了卒中的初始严重程度后，早期再通（P<0.001）和基于MR的侧支循环分级（P=0.001）与梗死增长独立相关，但靶点不匹配的存在与梗死增长无关。即使在靶点不匹配和成功再通的患者中，梗死生长的程度也取决于侧支循环状态。在较晚的Tmax时间点（超过动脉期）的灌注状态与侧支状态更密切相关。无论是否存在靶点不匹配模式，侧支循环良好的患者在梗死生长方面表现出良好的结局。缓慢的血液充盈预示着侧支循环状态和梗死的发展。
Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, using magnetic resonance perfusion (MRP) techniques. Consecutive patients who were candidates for recanalization therapy and underwent serial diffusion-weighted imaging (DWI) and MRP were enrolled. A collateral flow map derived from MRP source data was generated by automatic post-processing. The impact of a target mismatch (Tmax>6 s/apparent diffusion coefficient (ADC) volume≥1.8, ADC volume<70 mL; and Tmax>10 s for ADC volume<100 mL) on infarct growth was compared with MR-based collateral grading on day 7 DWI, using multivariate linear regression analysis. Among 73 patients, 55 (75%) showed a target mismatch, whereas collaterals were poor in 14 (19.2%), intermediate in 36 (49.3%), and good in 23 (31.5%) patients. After adjusting for initial severity of stroke, early recanalization (P<0.001) and the MR-based collateral grading (P=0.001), but not the presence of a target mismatch, were independently associated with infarct growth. Even in patients with a target mismatch and successful recanalization, the degree of infarct growth depended on the collateral status. Perfusion status at later Tmax time points (beyond the arterial phase) was more closely correlated with collateral status. Patients with good collaterals show a favorable outcome in terms of infarct growth, regardless of the presence of a target mismatch pattern. The presence of slow blood filling predicts collateral status and infarct growth.