Hyperintensity of Distal Vessels on FLAIR Is Associated with Slow Progression of the Infarction in Acute Ischemic Stroke
Hyperintensity of Distal Vessels on FLAIR Is Associated with Slow Progression of the Infarction in Acute Ischemic Stroke
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DOI：
10.1159/000343658
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Davalos, A.
中科院分区：
文献类型：
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作者：
Perez de la Ossa, N.;Hernandez-Perez, M.;Davalos, A.
背景：在急性卒中患者中，FLAIR-MRI上远端血管的高信号与较高级别的动脉侧支循环和较小的梗塞体积有关。没有研究分析高信号血管(HV)征象在最初几小时内对缺血进展速度的影响。我们的目的是研究HV征象与急性卒中患者脑梗塞进展的关系。方法：从一个前瞻性的卒中数据库中，我们回顾选择了我们综合卒中中心收治的前循环大动脉闭塞的急性卒中患者，这些患者有可用的基线CT扫描和随后进行的多模式磁共振成像，以决定血管内治疗。根据阿尔伯塔卒中计划早期CT扫描(Aspects)评分与弥散加权成像(DWI)评分的差值计算缺血区的进展。进展缓慢被认为是两次考试之间Aspects分数没有变化或下降1分。两位读者将FLAIR序列上HV的出现分为不存在、微妙或突出。结果：本研究共纳入70例患者。基线CT和MRI之间的平均时间为124±82min。基线CT的Aspects评分为10分的患者占34%，9分的患者占49%，8分以下的患者占17%。在DWI中，Aspects分数低了2(1-3)分，这种下降与两次考试之间经过的时间无关。57/70(81%)患者出现远端HV征(33例轻微，24例明显)。HV多见于近端动脉闭塞的患者。两组之间在卒中严重程度、卒中亚型和基线CT方面的得分没有差异。与轻度HV患者[中位方面评分下降2(2-1)]和无HV患者[中位方面评分下降3(4-3)]相比，重度HV患者的缺血区进展较慢[中位方面评分下降1(1-0)](p<；0.001)。多因素Logistic回归分析调整入院时的收缩压、闭塞部位和两次神经影像检查与无HV(OR，16.2；95%CI，2.1~123.1)和微小HV征象(OR，6.1；95%CI，1.5~2 3.9)之间的间隔时间，发现显著的HV与缓慢的缺血进展独立相关。结论：脑动脉前循环闭塞的急性卒中患者，FLAIR上的HV征象，尤其是显著的HV征象，与缺血区进展缓慢有关。这一放射征象可以预测缺血进展的速度，为在更长的时间窗内进行再灌注治疗打开了机会。版权所有(C)2012 S.Karger AG，巴塞尔
Background: Hyperintensity of distal vessels on FLAIR-MRI has been associated with a higher grade of arterial collaterals and a smaller infarct volume in acute stroke patients. No studies analyze the influence of the hyperintense vessel (HV) sign on the speed of the ischemia progression during the first hours. Our aim was to study the association of the HV sign with progression of infarction in acute stroke patients. Methods: From a prospectively derived stroke database, we retrospectively selected acute stroke patients with a large artery occlusion of the anterior circulation admitted to our comprehensive stroke center with available baseline CT scan and a multimodal MRI carried out thereafter to make a decision about endovascular treatment. Progression of the ischemic area was calculated as the difference in the Alberta Stroke Program Early CT Scan (ASPECTS) score between CT scan and diffusion-weighted imaging (DWI). Slow progression was considered as no change or 1 point decrease on the ASPECTS score between both exams. The presence of HV on FLAIR sequence was graded as absent, subtle or prominent by two readers. Results: A total of 70 patients were included in the study. Mean time between baseline CT and MRI was 124 +/- 82 min. ASPECTS score on baseline CT was 10 in 34% of patients, 9 in 49% and 8 or less in 17%. ASPECTS score was 2 (1-3) points lower in the DWI and this decrease did not correlate with the time elapsed between the two exams. Distal HV sign was observed in 57/70 (81%) patients (subtle in 33 and prominent in 24). HV was more frequently observed in patients with proximal artery occlusion. There were no differences regarding stroke severity, stroke subtype and ASPECTS score on baseline CT between groups. Patients with prominent HV showed a lower progression of the ischemic area [median ASPECTS score decrease, 1 (1-0)] compared with patients with subtle HV [median ASPECTS score decrease, 2 (2-1)] and patients with absence of HV [median ASPECTS score decrease, 3 (4-3)] (p < 0.001). Prominent HV was independently associated with slow progression of ischemia in a multivariate logistic regression analysis adjusted by systolic blood pressure on admission, site of occlusion and time elapsed between both neuroimaging exams compared to the absence of HV (OR, 16.2; 95% CI, 2.1-123.1) and to subtle HV sign (OR, 6.1; 95% CI, 1.5-23.9). Conclusion: HV sign on FLAIR, especially if prominent, is associated with a slow progression of the ischemic area in acute stroke patients with cerebral artery occlusion of the anterior circulation. This radiological sign may predict the speed of the ischemia progression, opening an opportunity for reperfusion therapies in longer time windows. Copyright (C) 2012 S. Karger AG, Basel