Fiehler Jens, von Bezold Michael, Kucinski Thomas, Knab René, Eckert Bernd, Wittkugel Oliver, Zeumer Hermann, Röther Joachim
Department of Neuroradiology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
Stroke. 2002 Oct;33(10):2421-5. doi: 10.1161/01.str.0000032554.19600.60.
We sought to study the role of MRI-derived cerebral blood flow (CBF) measurements for the prediction of lesion development in acute stroke patients.
Thirty-two patients were treated with tissue plasminogen activator. Diffusion-weighted (DWI) and perfusion-weighted MRI, T2-weighted imaging, and MR angiography were performed before treatment (2.8+/-0.9 hours after symptom onset) and on follow-up (days 1 and 7). CBF thresholds (12 and 22 mL/100 g per minute) were applied to bolus tracking MRI maps to determine predictive cutoff levels.
In 21 patients (group A), the terminal lesion volume (T2-weighted imaging) was larger than the initial DWI lesion volume (89+/-93 versus 21+/-38 mL). In 11 patients (group B), the terminal lesion volume was smaller than the initial DWI lesion volume (7+/-27 versus 15+/-29 mL). The initial DWI lesion volume did not differ between both groups. The presence of a tissue volume > or =50 mL with a CBF value < or =12 mL/100 g per minute was predictive for lesion enlargement to day 7 in T2-weighted imaging (positive predictive value, 0.80).
The presence of a tissue volume > or =50 mL with a CBF value < or =12 mL/100 g per minute predicts further lesion growth in hyperacute stroke patients. MRI-derived CBF values, with all their present limitations, are valuable in early estimation of prognosis of stroke patients.
我们试图研究磁共振成像（MRI）衍生的脑血流量（CBF）测量在预测急性中风患者病变发展中的作用。
32例患者接受了组织纤溶酶原激活剂治疗。在治疗前（症状发作后2.8±0.9小时）以及随访时（第1天和第7天）进行了扩散加权（DWI）和灌注加权MRI、T2加权成像以及磁共振血管造影。将CBF阈值（12和22 mL/100 g每分钟）应用于团注追踪MRI图像，以确定预测性临界水平。
21例患者（A组），最终病变体积（T2加权成像）大于初始DWI病变体积（89±93对21±38 mL）。11例患者（B组），最终病变体积小于初始DWI病变体积（7±27对15±29 mL）。两组之间初始DWI病变体积无差异。在T2加权成像中，存在组织体积≥50 mL且CBF值≤12 mL/100 g每分钟可预测至第7天病变扩大（阳性预测值，0.80）。
存在组织体积≥50 mL且CBF值≤12 mL/100 g每分钟可预测超急性中风患者病变进一步增长。尽管目前MRI衍生的CBF值存在局限性，但在早期评估中风患者预后方面具有重要价值。
