Early Change in Stroke Size Performs Best in Predicting Response to Therapy.
Early Change in Stroke Size Performs Best in Predicting Response to Therapy.
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DOI：
10.1159/000477945
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
NIH Natural History of Stroke Investigators
中科院分区：
文献类型：
--
作者：
Simpkins AN;Dias C;Norato G;Kim E;Leigh R;NIH Natural History of Stroke Investigators
需要可靠的成像生物标志物来评估急性卒中治疗的反应。最终梗死体积和早期再灌注百分比已用于此目的。中风大小的早期波动是一种公认的现象，但其作为治疗反应的生物标志物的效用尚未确定。本研究比较了每搏输出量早期变化与最终梗死体积和早期再灌注百分比在识别早期神经功能改善（ENI）方面的临床相关性。2013-2014年入组的接受溶栓治疗的急性卒中患者接受了连续MRI扫描（治疗前基线、治疗后2小时和治疗后24小时）。从基线计算每搏输出量的早期变化、24小时弥散时的梗死体积和早期再灌注百分比，并比较2小时MRI扫描。ENI定义为24小时内NIHSS降低≥4分。采用Logistic回归模型和受试者操作特征分析比较三种影像学标志物的有效性。分析了58例急性脑卒中患者的系列MRI。通过逻辑回归分析，每搏输出量的早期变化与ENI显著相关（p = 0.048，OR 0.93），并且在控制卒中大小和严重程度后仍然显著（p = 0.032，OR 0.90）。因此，每搏输出量每增加1 mL，ENI的几率就降低10%，而每搏输出量每减少1 mL，ENI的几率就增加10%。Logistic回归分析显示，24小时梗死体积和早期再灌注百分比与ENI均无显著相关性。受试者操作者特征分析将每搏输出量的早期变化确定为三种生物标志物中唯一表现为显著不同于偶然性的生物标志物（p = 0.03）。与传统的最终梗死体积和早期再灌注百分比相比，卒中面积的早期波动可能代表了对治疗反应的更可靠的生物标志物。
Reliable imaging biomarkers of response to therapy in acute stroke are needed. Final infarct volume and percent early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume comparing it with final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI). Acute stroke patients enrolled 2013-2014 with serial MRI scans (pre-treatment baseline, 2 hours post, and 24 hours post) who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 hours on diffusion, and percent early reperfusion were calculated from the baseline and 2 hour MRI scans were compared. ENI was defined as ≥4 point decrease in NIHSS within 24 hours. Logistic regression models and receiver operator characteristics analysis were used to compare the effectives of three imaging biomarkers. Serial MRIs of 58 acute stroke patients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (p = 0.048, OR 0.93) and remained significant after controlling for stroke size and severity (p = 0.032, OR 0.90). Thus for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 hours nor percent early reperfusion were significantly associated with ENI by logistic regression. Receiver operator characteristic analysis identified early change in stroke volume as the only biomarker of the three that performed significantly different than chance (p = 0.03). Early fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the more traditional measures of final infarct volume and percent early reperfusion.
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影响因子：
6.3
作者：
Campbell, Bruce C. V.;Purushotham, Archana;Davis, Stephen M.
通讯作者：
Davis, Stephen M.
DOI：
10.1016/s1474-4422(12)70203-x
发表时间：
2012-10
期刊：
The Lancet. Neurology
影响因子：
--
作者：
Lansberg MG;Straka M;Kemp S;Mlynash M;Wechsler LR;Jovin TG;Wilder MJ;Lutsep HL;Czartoski TJ;Bernstein RA;Chang CW;Warach S;Fazekas F;Inoue M;Tipirneni A;Hamilton SA;Zaharchuk G;Marks MP;Bammer R;Albers GW;DEFUSE 2 study investigators
通讯作者：
DEFUSE 2 study investigators
影响因子：
8.3
作者：
Albers, Gregory W.;Goyal, Mayank;Saver, Jeffrey L.
通讯作者：
Saver, Jeffrey L.
影响因子：
6.7
作者：
Sakamoto, Yuki;Kimura, Kazumi;Iguchi, Yasuyuki
通讯作者：
Iguchi, Yasuyuki
影响因子：
8.3
作者：
Fiehler, J;Knudsen, K;Röther, J
通讯作者：
Röther, J