MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter
MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter
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DOI：
10.1159/000444131
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发表时间：
2016-01-01
影响因子：
2.9
通讯作者：
Berthezene, Yves
中科院分区：
文献类型：
--
作者：
Berner, Lise-Prune;Cho, Tae-Hee;Berthezene, Yves
背景：在急性缺血性卒中（AIS）中，灰质（GM）和白色物质（WM）对缺血的易感性不同。因此，我们使用MRI比较了WM和GM内缺血性病变的演变。研究方法：从欧洲多中心前瞻性数据库（I-KNOW）中，确定了50例存在前部AIS且灌注加权成像（PWI）/弥散加权成像（DWI）不匹配比≥ 1.2的患者的可用T1加权图像。共列出了6个病变区：初始DWI（B = 1,000 s/mm（2））病变、初始PWI-DWI不匹配（Tmax>4 s且DWI阴性）、1个月液体衰减反转恢复（FLAIR）成像上的最终梗死、急性DWI和1个月FLAIR之间的病变生长、1个月时DWI病变逆转和挽救性不匹配。在T1加权图像上分割WM和GM，所有图像在受试者内与基线MRI共配准。计算每个隔室的WM和GM比例。结果：50名患者有资格参加本研究。症状出现与基线MRI之间的中位延迟时间为140分钟。以下部分的WM百分比显着更大：初始不匹配（52.5%与47.5%，p = 0.003）、最终梗死（56.7%与43.3%，p < 0.001）和病变生长（58.9%与41.2%，p < 0.001）。在初始DWI病变、DWI逆转和挽救的不匹配隔室中，GM和WM百分比之间无显著差异。结论：缺血性病变可优先在WM内扩展。针对WM缺血过程的具体治疗策略可能值得进一步研究。(C)2016 S. Karger AG，巴塞尔
Background: In acute ischemic stroke (AIS), gray matter (GM) and white matter (WM) have different vulnerabilities to ischemia. Thus, we compared the evolution of ischemic lesions within WM and GM using MRI. Methods: From a European multicenter prospective database (I-KNOW), available T1-weighted images were identified for 50 patients presenting with an anterior AIS and a perfusion weighted imaging (PWI)/diffusion weighted imaging (DWI) mismatch ratio of 1.2 or more. Six lesion compartments were outlined: initial DWI (b = 1,000 s/mm(2)) lesion, initial PWI-DWI mismatch (T-max >4 s and DWI-negative), final infarct mapped on 1-month fluid-attenuated inversion recovery (FLAIR) imaging, lesion growth between acute DWI and 1-month FLAIR, DWI lesion reversal at 1 month and salvaged mismatch. The WM and GM were segmented on T1-weighted images, and all images were co-registered within subjects to the baseline MRI. WM and GM proportions were calculated for each compartment. Results: Fifty patients were eligible for the study. Median delay between symptom onset and baseline MRI was 140 min. The percentage of WM was significantly greater in the following compartments: initial mismatch (52.5 vs. 47.5%, p = 0.003), final infarct (56.7 vs. 43.3%, p < 0.001) and lesion growth (58.9 vs. 41.2%, p < 0.001). No significant difference was found between GM and WM percentages within the initial DWI lesion, DWI reversal and salvaged mismatch compartments. Conclusions: Ischemic lesions may extend preferentially within the WM. Specific therapeutic strategies targeting WM ischemic processes may deserve further investigation. (C) 2016 S. Karger AG, Basel