Lee L J, Kidwell C S, Alger J, Starkman S, Saver J L
University of California Los Angeles Stroke Center, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA.
Stroke. 2000 May;31(5):1081-9. doi: 10.1161/01.str.31.5.1081.
The purpose of the present study was to assess the diagnostic usefulness of early diffusion-weighted MRI (DWI) and MR angiography (MRA) in patients with ischemic stroke. Past approaches to stroke diagnosis required a series of diagnostic tests over several days of hospitalization. New magnetic resonance methodologies that include DWI and MRA may allow more rapid characterization of stroke pathophysiology. However, no previous study has assessed the impact on formal stroke subtype diagnosis of early imaging with DWI/MRA.
We analyzed 46 consecutive patients with acute ischemic stroke who underwent DWI/MRA within 24 hours of admission. Initial diagnoses were rendered with use of the 2 most widely used formal stroke subtype classification schemes, the TOAST and the Oxfordshire methods, which were applied to patients after CT/conventional MRI but before DWI/MRA. Modified TOAST and Oxfordshire diagnoses were then rendered based on the results of day 1 DWI, MRA, and DWI plus MRA. Final TOAST/Oxfordshire diagnoses at discharge were taken as the gold standard.
Compared with final diagnoses, pre-MRI TOAST diagnoses matched final diagnoses in 48%, improving to 83% after DWI alone, 56% after MRA alone, and 94% after DWI plus MRA. For the TOAST diagnostic subtypes of large-vessel atherothromboembolism and small-vessel disease, pre-MRI diagnoses matched final diagnoses in 56% and 35% of patients, respectively, improving to 89% and 100% after DWI/MRA. Pre-MRI Oxfordshire diagnoses matched final diagnoses in 67% of patients, improving to 100% after DWI.
The use of DWI/MRA within 24 hours of hospitalization substantially improves the accuracy of the diagnosis of early ischemic stroke subtype. When initial management and clinical trial eligibility decisions are influenced by stroke subtype, day 1 multimodal MRI is advantageous as a guide to therapy.
本研究旨在评估早期弥散加权磁共振成像（DWI）和磁共振血管造影（MRA）对缺血性脑卒中患者的诊断价值。过去的脑卒中诊断方法需要在住院数天内进行一系列诊断检查。包括DWI和MRA在内的新磁共振方法可能有助于更快速地明确脑卒中的病理生理特征。然而，此前尚无研究评估早期DWI/MRA成像对正式脑卒中亚型诊断的影响。
我们分析了46例急性缺血性脑卒中患者，这些患者在入院24小时内接受了DWI/MRA检查。最初的诊断采用两种应用最广泛的正式脑卒中亚型分类方案，即TOAST和牛津郡方法，在患者接受CT/传统MRI检查后但在DWI/MRA检查前应用于患者。然后根据第1天DWI、MRA以及DWI加MRA的结果做出改良的TOAST和牛津郡诊断。出院时的最终TOAST/牛津郡诊断被视为金标准。
与最终诊断相比，MRI检查前TOAST诊断与最终诊断相符的比例为48%，仅DWI检查后升至83%，仅MRA检查后为56%，DWI加MRA检查后为94%。对于TOAST诊断亚型中的大动脉粥样硬化血栓形成和小血管疾病，MRI检查前诊断与最终诊断相符的患者分别为56%和35%，DWI/MRA检查后升至89%和100%。MRI检查前牛津郡诊断与最终诊断相符的患者为67%，DWI检查后升至100%。
住院24小时内使用DWI/MRA可显著提高早期缺血性脑卒中亚型诊断的准确性。当初始治疗和临床试验入选决策受脑卒中亚型影响时，第1天的多模态MRI作为治疗指导具有优势。
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