Early ischaemic diffusion lesion reduction in patients treated with intravenous tissue plasminogen activator: infrequent, but significantly associated with recanalization
Early ischaemic diffusion lesion reduction in patients treated with intravenous tissue plasminogen activator: infrequent, but significantly associated with recanalization
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DOI：
10.1111/j.1747-4949.2012.00902.x
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发表时间：
2013-07-01
影响因子：
6.7
通讯作者：
Iguchi, Yasuyuki
中科院分区：
文献类型：
--
作者：
Sakamoto, Yuki;Kimura, Kazumi;Iguchi, Yasuyuki
背景与目的近年来研究表明，溶栓治疗可减少或消除脑缺血性弥散加权成像病变。然而，这种弥散加权成像病变减少的特征并不为人所知。目的为了澄清，研究了与病变缩小相关的频率和因素。方法前瞻性纳入在发病3小时内接受静脉组织型纤溶酶原激活剂治疗的患者。磁共振成像包括弥散加权成像和磁共振血管造影进行了四次：入院时，静脉注射组织纤溶酶原激活剂后，静脉注射组织纤溶酶原激活剂后24小时，静脉注射组织纤溶酶原激活剂后7天。使用美国国立卫生研究院成像软件通过手动描记测量弥散加权成像病变体积。根据早期弥散加权成像病灶体积从入院到静脉注射组织型纤溶酶原激活剂后的变化，将所有患者分为三组：病灶缩小组（减少>20%）;病灶增长组（增加>20%）;和病灶不变组。结果共纳入105例患者[56例男性，中位年龄77（四分位距70-83）岁，美国国立卫生研究院卒中量表评分16（10-22）]。在7例（7%）患者中观察到早期弥散加权成像病变缩小。减少的病变随后增加。在多变量分析中，入院时的血糖水平（比值比0中心点95，95%置信区间0中心点91至0中心点99，P=0中心点045）和早期再通（比值比15中心点7，95%置信区间1中心点61至153，P=0中心点018）与早期病变缩小独立相关。结论在接受静脉注射组织型纤溶酶原激活剂治疗的患者中，观察到7%的患者早期弥散加权成像病变缩小。减少的病变随后增加。初始血糖水平和早期再通与早期弥散加权成像病变减少独立相关。
Background and purpose Recent studies have shown that thrombolysis could decrease or eliminate ischaemic diffusion-weighted imaging lesions. However, the features of such diffusion-weighted imaging lesion reduction are not well known. Aims To clarify, the frequency of and factors associated with lesion reduction were investigated. Methods Patients given intravenous tissue plasminogen activator therapy within three-hours of onset were prospectively enrolled. Magnetic resonance imaging including diffusion-weighted imaging and magnetic resonance angiography was performed four times: on admission, just after intravenous tissue plasminogen activator, 24h from intravenous tissue plasminogen activator, and seven-days after intravenous tissue plasminogen activator. The diffusion-weighted imaging lesion volume was measured by manual trace using National Institutes of Health imaging software. All patients were divided into three groups according to the early diffusion-weighted imaging lesion volume change from admission to just after intravenous tissue plasminogen activator: the lesion reduction group (>20% decrease); the lesion growth group (>20% increase); and the lesion unchanged group. Results In total, 105 patients [56 males, median age 77 (interquartile range 70-83) years, and National Institutes of Health Stroke Scale score 16 (10-22)] were enrolled. Early diffusion-weighted imaging lesion reduction was observed in seven (7%) patients. The decreased lesion increased subsequently. On multivariate analysis, the glucose level on admission (odds ratio 0 center dot 95, 95% confidence interval 0 center dot 91 to 0 center dot 99, P=0 center dot 045) and early recanalization (odds ratio 15 center dot 7, 95% confidence interval 1 center dot 61 to 153, P=0 center dot 018) were independently related to early lesion reduction. Conclusion Early diffusion-weighted imaging lesion reduction was observed in 7% of patients treated with intravenous tissue plasminogen activator. The decreased lesion increased subsequently. Initial glucose level and early recanalization were independently associated with early diffusion-weighted imaging lesion reduction.