Oppenheim C, Samson Y, Dormont D, Crozier S, Manaï R, Rancurel G, Frédy D, Marsault C
Fédération de Neuroradiologie, Université Paris VI, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris.
J Neuroradiol. 2002 Mar;29(1):6-13.
Symptomatic hemorrhagic transformation is a severe complication of acute ischemic stroke which occurs at a higher frequency after thrombolysis. The present study was designed to analyze whether early DWI can be used for predicting the risk of hemorrhagic transformation with clinical worsening in MCA stroke patients.
Of 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MR angiography performed within 14 hours after onset (mean 6.5 +/- 3.5 hours, median 5.2 hours), 4 developed hemorrhagic transformation with clinical worsening, while 24 did not. For the 2 groups, we compared admission NIHSS score, site of arterial occlusion, volume of DWI abnormalities, and several apparent diffusion coefficient (ADC) measurements: ADC(infarct) (mean ADC value of the whole infarct), ADC(core) (peak ADC decrease as calculated in a 57 mm(2) circular ROI, manually centered on the ischemic area with the lowest ADC value on the ADC maps), ADC(superficial) and ADC(deep). Discriminant function analysis was used to determine the most accurate predictors of symptomatic hemorrhagic transformation.
The best predictor was the ADC(core) (F=5.34, p=2.9%, cut-off value=300 x 10(-6) mm(2)/s). This monovariate model allowed to correctly classify all 4 patients (ADC(core) 300 x 10(-6) mm(2)/s) with subsequent symptomatic hemorrhage, and 17 of the 24 patients without symptomatic hemmorrhage (ADC(core)>300 x 10(-6) mm(2)/s) (100% sensitivity, 71% specificity).
Although preliminary, these results suggest that a simple measurement of minimum ADC values within an acute MCA stroke could be useful in targeting those patients with a high risk of severe hemorrhagic transformation.
症状性出血转化是急性缺血性卒中的一种严重并发症，在溶栓后发生频率更高。本研究旨在分析早期弥散加权成像（DWI）是否可用于预测大脑中动脉（MCA）卒中患者发生出血转化且临床症状恶化的风险。
28例大脑中动脉梗死患者，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，证实存在大脑中动脉或颈动脉T闭塞，其中4例发生出血转化且临床症状恶化，24例未发生。对于这两组患者，我们比较了入院时美国国立卫生研究院卒中量表（NIHSS）评分、动脉闭塞部位、DWI异常体积以及几个表观扩散系数（ADC）测量值：ADC（梗死灶）（整个梗死灶的平均ADC值）、ADC（核心区）（在ADC图上以缺血区最低ADC值为中心手动绘制的57平方毫米圆形感兴趣区内计算得出的ADC峰值下降）、ADC（浅表层）和ADC（深部）。采用判别函数分析来确定症状性出血转化的最准确预测指标。
最佳预测指标是ADC（核心区）（F = 5.34，p = 2.9%，临界值 = 300×10⁻⁶平方毫米/秒）。该单变量模型能够正确分类所有4例随后发生症状性出血的患者（ADC（核心区）<300×10⁻⁶平方毫米/秒），以及24例无症状性出血患者中的17例（ADC（核心区）>300×10⁻⁶平方毫米/秒）（敏感性100%，特异性71%）。
尽管这些结果是初步的，但表明在急性大脑中动脉卒中患者中简单测量最小ADC值可能有助于确定那些发生严重出血转化风险高的患者。
