Kluytmans M, van Everdingen K J, Kappelle L J, Ramos L M, Viergever M A, van der Grond J
Department of Radiology, Image Sciences Institute, University Hospital Utrecht, The Netherlands.
Eur Radiol. 2000;10(9):1434-41. doi: 10.1007/s003300000501.
The aim of this study was to evaluate the differences in cerebral perfusion seen on mean transit time (MTT) and cerebral blood volume (CBV) maps and to assess the subsequent prognostic value of the MTT-DWI (diffusion-weighted MRI) and CBV-DWI mismatch in the first three days of stroke on lesion enlargement and clinical outcome. In 38 patients, imaged 1-46 h after onset of symptoms, lesion volumes on proton-density (PD)-weighted MRI, DWI and PWI (both MTT and CBV maps) were compared with lesion volumes on follow-up PD-weighted scans, and to clinical outcome (National Institutes of Health Stroke Scale, Barthel index, and Rankin scale). The MTT-CBV, MTT-DWI and CBV-DWI mismatches were compared with change in lesion volume between initial and follow-up PD-weighted scans. Lesion volume on both DWI and PWI correlated significantly with clinical outcome parameters (p < 0.001) with strongest correlation for lesion volume on CBV. Perfusion-diffusion mismatches were found for both CBV and MTT and correlated significantly with lesion enlargement on PDweighted imaging with strongest correlation for the CBV-DWI mismatch. The CBV-DWI mismatch has the highest accuracy in predicting lesion size on follow-up imaging and in predicting clinical outcome. Lesion volume measurements on CBV maps have a higher specificity than on PD-weighted, MTT or DWI images in predicting clinical follow-up imaging and in predicting clinical outcome.
本研究的目的是评估平均通过时间（MTT）和脑血容量（CBV）图上所见的脑灌注差异，并评估卒中发病后头三天MTT-扩散加权成像（DWI）和CBV-DWI不匹配对病变扩大和临床结局的后续预后价值。对38例症状发作后1-46小时进行成像的患者，将质子密度（PD）加权MRI、DWI和灌注加权成像（MTT和CBV图）上的病变体积与随访PD加权扫描上的病变体积以及临床结局（美国国立卫生研究院卒中量表、巴氏指数和Rankin量表）进行比较。将MTT-CBV、MTT-DWI和CBV-DWI不匹配与初始和随访PD加权扫描之间的病变体积变化进行比较。DWI和灌注加权成像上的病变体积均与临床结局参数显著相关（p<0.001），CBV上的病变体积相关性最强。CBV和MTT均发现灌注-扩散不匹配，且与PD加权成像上的病变扩大显著相关，CBV-DWI不匹配相关性最强。CBV-DWI不匹配在预测随访成像上的病变大小和临床结局方面具有最高的准确性。在预测临床随访成像和临床结局方面，CBV图上的病变体积测量比PD加权、MTT或DWI图像具有更高的特异性。
