Signal evolution and infarction risk for apparent diffusion coefficient lesions in acute ischemic stroke are both time- and perfusion-dependent.
Signal evolution and infarction risk for apparent diffusion coefficient lesions in acute ischemic stroke are both time- and perfusion-dependent.
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DOI：
10.1161/strokeaha.110.610501
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发表时间：
2011-05
期刊：
影响因子：
8.3
通讯作者：
Lin W
中科院分区：
文献类型：
--
作者：
An H;Ford AL;Vo K;Powers WJ;Lee JM;Lin W
本研究旨在探讨缺血性中风发作 6 小时内组织灌注与表观扩散系数 (ADC) 变化之间的时间关系，以及不同的再灌注模式如何影响 ADC 损伤的组织结果。 31 名参与者在中风后 3 小时、6 小时和 1 个月依次进行成像。在初始 ADC 损伤内定义了三个感兴趣区域 (ROI)：ROI(1)reperf3hr 超急性再灌注（3 小时内）、ROI(2)reperf6hr 急性再灌注（3-6 小时）和 ROI(3)nonreperf 无再灌注（6 小时内）。对于每个 ROI，检查 3 至 6 小时内 ADC (ΔADC) 的变化以及梗塞风险。所有三个 ROI 中初始 ADC 降低的幅度相似 (P=0.51)。 ΔADC 与再灌注密切相关 (P<0.0001)，但与初始 ADC 降低无关 (P=0.83)。 ROI(1)reperf3hr、ROI(2)reperf6hr的ΔADC显着大于ROI(3)nonreperf(P<0.05)。在 ROI(1)reperf3hr 中 3 至 6 小时内获得阳性 ΔADC，该 ROI(1)reperf3hr 在 3 小时前已恢复灌注，这表明再灌注和 ADC 变化之间存在时间延迟。 ROI(3)nonreperf组的梗死风险显着高于ROI(1)reperf3hr和ROI(2)reperf6hr组。 ADC 的改善并非与再灌注同时发生，而是表现出时间延迟。 3 小时时具有相似初始 ADC 降低的区域具有不同的 ADC 演变和梗死风险，具体取决于组织何时或是否再灌注。这些发现为以下观察提供了生理学基础：中风发作后固定时间的单个 ADC 测量可能无法准确预测组织结果。
This study aimed to examine the temporal relationship between tissue perfusion and apparent diffusion coefficient (ADC) changes within 6 hours of ischemic stroke onset and how different reperfusion patterns may affect tissue outcome in ADC lesion. Thirty-one participants were sequentially imaged at 3 hours, 6 hours and 1 month post stroke. Three regions of interest (ROIs) were defined within initial ADC lesions: ROI(1)reperf3hr hyper-acute reperfusion (within 3 hours), ROI(2)reperf6hr acute reperfusion (3-6 hours), and ROI(3)nonreperf no reperfusion (by 6 hours). For each ROI, changes of ADC (ΔADC) from 3 to 6 hours and risks of infarction were examined. The magnitude of initial ADC reduction was similar in all three ROIs (P=0.51). ΔADC were strongly associated with reperfusion (P<0.0001) but not with initial ADC reduction (P=0.83). ΔADC in ROI(1)reperf3hr, ROI(2)reperf6hr were significantly larger than that of ROI(3)nonreperf (P<0.05). Positive ΔADC were obtained from 3 to 6 hours in ROI(1)reperf3hr that had restored perfusion prior to 3 hours, demonstrating a temporal delay between reperfusion and ADC changes. Risk of infarction were significantly higher in ROI(3)nonreperf than those in ROI(1)reperf3hr and ROI(2)reperf6hr. Improvement of ADC did not occur coincidently with reperfusion but showed a temporal delay. Regions with similar initial ADC reductions at 3 hours had different evolution of ADC and infarction risks depending on when or if tissue reperfused. These findings provide a physiological basis for the observation that a single ADC measurement at a fixed time after stroke onset may not accurately predict tissue outcome.