Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke.
Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke.
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DOI：
10.1186/1471-2377-12-132
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发表时间：
2012-11-05
期刊：
影响因子：
2.6
通讯作者：
González RG
中科院分区：
文献类型：
--
作者：
Hakimelahi R;Yoo AJ;He J;Schwamm LH;Lev MH;Schaefer PW;González RG
我们检验了以下假设：在颈内动脉末端和/或大脑中动脉近端闭塞的患者中，弥散异常≤ 70 ml时，弥散/灌注不匹配至少为100%。回顾性确定了68例伊卡终末和/或MCA近端闭塞且在卒中发作24小时内接受弥散/灌注MRI的连续患者。测量DWI和平均通过时间（MTT）体积。首先，48名连续患者被确定为具有相同的入选标准。测量DWI和达峰时间（TTP）病变体积。大的不匹配体积被定义为MTT或TTP异常至少是DWI病变体积的两倍。在回顾性研究中，68例患者中有49例的DWI病变体积≤ 70 ml（平均20.2 ml; SEM 2.9 ml）。在所有49例患者中观察到DWI/MTT错配> 100%（P < .0001）。在前瞻性研究中，35/48例患者的DWI体积≤ 70 ml（平均18.7 ml; SEM 3.0 ml）。所有35例患者的错配率均> 100%（P < .0001）。如果弥散病变体积小于或等于70 ml，则急性脑卒中患者的主要前循环动脉闭塞极有可能出现弥散/灌注不匹配，这表明仅使用血管成像和弥散MRI作为灌注成像的简单替代方案，可以进行基于生理学的患者评估。
We tested the hypothesis that in patients with occlusion of the terminal internal carotid artery and/or the proximal middle cerebral artery, a diffusion abnormality of 70 ml or less is accompanied by a diffusion/perfusion mismatch of at least 100%. Sixty-eight consecutive patients with terminal ICA and/or proximal MCA occlusions and who underwent diffusion/perfusion MRI within 24 hours of stroke onset were retrospectively identified. DWI and mean transit time (MTT) volumes were measured. Prospectively, 48 consecutive patients were identified with the same inclusion criteria. DWI and time to peak (TTP) lesion volumes were measured. A large mismatch volume was defined as an MTT or TTP abnormality at least twice the DWI lesion volume. In the retrospective study, 49 of 68 patients had a DWI lesion volume ≤ 70 ml (mean 20.2 ml; SEM 2.9 ml). A DWI/MTT mismatch of > 100% was observed in all 49 patients (P < .0001). In the prospective study, there were 35/48 patients with DWI volumes ≤ 70 ml (mean 18.7 ml; SEM 3.0 ml). A mismatch > 100% was present in all 35 (P < .0001). Acute stroke patients with major anterior circulation artery occlusion are exceedingly likely to have a major diffusion/perfusion mismatch if the diffusion lesion volume is 70 ml or less. This suggests that physiology-based patient assessments may be made using only vessel imaging and diffusion MRI as a simple alternative to perfusion imaging.
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