Oppenheim C, Samson Y, Manaï R, Lalam T, Vandamme X, Crozier S, Srour A, Cornu P, Dormont D, Rancurel G, Marsault C
Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Stroke. 2000 Sep;31(9):2175-81. doi: 10.1161/01.str.31.9.2175.
This study was designed to analyze whether early diffusion-weighted imaging (DWI) provides reliable quantitative information for the prediction of stroke patients at risk of malignant brain infarct.
We selected 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MRI angiography performed within 14 hours after onset (mean 6.5+/-3.5 hours, median 5.2 hours). Of these, 10 patients developed malignant MCA infarct, whereas 18 did not. For the 2 groups, we compared the National Institutes of Health Stroke Scale (NIHSS) score at admission, site of arterial occlusion, standardized visual analysis of DWI abnormalities, quantitative volume measurement of DWI abnormalities (volume(DWI)), and apparent diffusion coefficient values. Univariate and multivariate discriminant analysis was used to determine the most accurate predictors of malignant MCA infarct.
Univariate analysis showed that an admission NIHSS score >20, total versus partial MCA infarct, and volume(DWI) >145 cm(3) were highly significant predictors of malignant infarct. The best predictor was volume(DWI) >145 cm(3), which achieved 100% sensitivity and 94% specificity. Prediction was further improved by bivariate models combining volume(DWI) and apparent diffusion coefficient measurements, which reached 100% sensitivity and specificity in this series of patients.
Quantitative measurement of infarct volume on DWI is an accurate method for the prediction of malignant MCA infarct in patients with persistent arterial occlusion imaged within 14 hours of onset. This may be of importance for early management of severe stroke patients.
本研究旨在分析早期弥散加权成像（DWI）是否能为预测有恶性脑梗死风险的卒中患者提供可靠的定量信息。
我们选取了28例大脑中动脉（MCA）梗死患者，这些患者在发病后14小时内（平均6.5±3.5小时，中位数5.2小时）进行了DWI及磁共振血管造影检查，且证实存在MCA或颈动脉T闭塞。其中，10例患者发生了恶性MCA梗死，而18例未发生。对于这两组患者，我们比较了入院时的美国国立卫生研究院卒中量表（NIHSS）评分、动脉闭塞部位、DWI异常的标准化视觉分析、DWI异常的定量体积测量（体积（DWI））以及表观扩散系数值。采用单因素和多因素判别分析来确定恶性MCA梗死最准确的预测指标。
单因素分析显示，入院时NIHSS评分>20、MCA完全梗死与部分梗死以及体积（DWI）>145 cm³是恶性梗死的高度显著预测指标。最佳预测指标是体积（DWI）>145 cm³，其敏感性达100%，特异性达94%。结合体积（DWI）和表观扩散系数测量的双变量模型进一步提高了预测准确性，在这组患者中敏感性和特异性均达到100%。
对发病14小时内成像且存在持续性动脉闭塞的患者，通过DWI定量测量梗死体积是预测恶性MCA梗死的准确方法。这对于重症卒中患者的早期管理可能具有重要意义。
