Regional Very Low Cerebral Blood Volume Predicts Hemorrhagic Transformation Better Than Diffusion-Weighted Imaging Volume and Thresholded Apparent Diffusion Coefficient in Acute Ischemic Stroke
Regional Very Low Cerebral Blood Volume Predicts Hemorrhagic Transformation Better Than Diffusion-Weighted Imaging Volume and Thresholded Apparent Diffusion Coefficient in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.109.562116
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发表时间：
2010-01-01
期刊：
影响因子：
8.3
通讯作者：
Davis, Stephen M.
中科院分区：
文献类型：
--
作者：
Campbell, Bruce C. V.;Christensen, Soren;Davis, Stephen M.
背景和目的--目前，弥散加权成像(DWI)病变体积是最有用的预测出血转化(HT)的磁共振成像指标。初步研究表明，非常低的脑血容量(VLCBV)预示着高血压。我们使用GERTET研究的数据比较了VLCBV和DWI对HT的预测。方法-从非中风半球计算正常百分位数的CBV值。创建了CBV阈值为<；0、2.5、5和10%的全脑面具。计算急性DWI缺血灶内VLCBV的组织体积。结果91例患者中有44例发生了-HT。有症状性脑实质血肿13例(4例)，无症状出血性脑梗塞31例。PH组VLCBV的中位数明显高于对照组。在受试者操作特征分析和Logistic回归分析中，VLCBV对HT的预测优于DWI和以表观弥散系数为阈值的病变体积。2mLVLCBV与2.5百分位数的切点对PH的敏感性为100%，在接受组织纤溶酶原激活剂治疗的患者中，定义为PH风险为43%的人群(95%CI，23%至66%，似然比=16)。在与传统临床危险因素的多因素分析中，VLCBV仍然是PH的独立预测因子。结论：在这个大的患者队列中，VLCBV预测溶栓后的HT比DWI或表观弥散系数体积更好。这一优势在DWI体积较小的患者中最大。在再通的患者中，预测更好。如果在独立的队列中得到验证，在溶栓前决策中加入VLCBV可能会降低HT的发生率。(笔划。2010；41：82-88。)
Background and Purpose-Currently, diffusion-weighted imaging (DWI) lesion volume is the most useful magnetic resonance imaging predictor of hemorrhagic transformation (HT). Preliminary studies have suggested that very low cerebral blood volume (VLCBV) predicts HT. We compared HT prediction by VLCBV and DWI using data from the EPITHET study.Methods-Normal-percentile CBV values were calculated from the nonstroke hemisphere. Whole-brain masks with CBV thresholds of the < 0, 2.5, 5, and 10th percentiles were created. The volume of tissue with VLCBV was calculated within the acute DWI ischemic lesion. HT was graded as per ECASS criteria.Results-HT occurred in 44 of 91 patients. Parenchymal hematoma (PH) occurred in 13 (4 symptomatic) and asymptomatic hemorrhagic infarction (HI) in 31. The median volume of VLCBV was significantly higher in cases with PH. VLCBV predicted HT better than DWI lesion volume and thresholded apparent diffusion coefficient lesion volume in receiver operating characteristic analysis and logistic regression. A cutpoint at 2 mL VLCBV with the < 2.5th percentile had 100% sensitivity for PH and, in patients treated with tissue plasminogen activator, defined a population with a 43% risk of PH (95% CI, 23% to 66%, likelihood ratio = 16). VLCBV remained an independent predictor of PH in multivariate analysis with traditional clinical risk factors for HT.Conclusions-VLCBV predicted HT after thrombolysis better than did DWI or apparent diffusion coefficient volume in this large patient cohort. The advantage was greatest in patients with smaller DWI volumes. Prediction was better in patients who recanalized. If validated in an independent cohort, the addition of VLCBV to prethrombolysis decision making may reduce the incidence of HT. (Stroke. 2010;41:82-88.)