Thomalla Götz J, Kucinski Thomas, Schoder Volker, Fiehler Jens, Knab Rene, Zeumer Herrmann, Weiller Cornelius, Röther Joachim
Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrabetae 52, D-20246 Hamburg, Germany.
Stroke. 2003 Aug;34(8):1892-9. doi: 10.1161/01.STR.0000081985.44625.B6. Epub 2003 Jul 10.
We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI).
Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient <80% (ADC<80%) and time to peak >+4 seconds (TTP>+4s) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADCcore) and relative ADC within the ADC<80% lesion (rADClesion) were measured. Neurological deficit at admission was assessed with the National Institutes of Health Stroke Scale (NIHSS).
Patients with MMI showed larger ADC<80% (median, 157 versus 22 mL; P<0.001) and TTP>+4s (208 versus 125 mL; P<0.001) lesion volumes, smaller TTP/ADC mismatch ratio (1.5 versus 5.5; P<0.001), lower ADCcore values (290 versus 411 mm2/s; P<0.001), lower rADClesion (0.60 versus 0.66; P=0.001), higher frequency of carotid-T occlusion (64% versus 15%; P=0.006), and higher NIHSS score at admission (20 versus 15; P=0.001). Predictors of MMI were as follows for sensitivity and specificity, respectively: ADC<80% >82 mL, 87%, 91%; TTP>+4s >162 mL, 83%, 75%; TTP/ADC mismatch ratio <2.4, 80%, 79%; ADCcore <300 mm2/s, 83%, 85%; rADClesion <0.62, 79%, 74%; and NIHSS score at admission > or =19, 96%, 72%.
Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.
我们验证了以下假设，即早期弥散加权磁共振成像（DWI）和灌注加权磁共振成像（PWI）能够预测恶性大脑中动脉（MCA）梗死（MMI）。
对37例急性MCA梗死且近端血管闭塞（颈动脉-T段、MCA主干）的患者在症状发作6小时内进行了DWI、PWI及磁共振血管造影检查。11例患者发生了MMI，其定义为意识下降及占位性脑水肿的影像学表现。与未受累半球相比，病变体积回顾性定义为表观扩散系数<80%（ADC<80%）及达峰时间>+4秒（TTP>+4s）。测量梗死核心区的ADC降低值（ADCcore）及ADC<80%病变内的相对ADC（rADClesion）。入院时的神经功能缺损用美国国立卫生研究院卒中量表（NIHSS）进行评估。
发生MMI的患者表现出更大的ADC<80%病变体积（中位数分别为157与22 mL；P<0.001）及TTP>+4s病变体积（208与125 mL；P<0.001），更小的TTP/ADC错配率（1.5与5.5；P<0.001），更低的ADCcore值（290与411 mm2/s；P<0.001），更低的rADClesion（0.60与0.66；P=0.001），更高的颈动脉-T段闭塞频率（64%与15%；P=0.006），以及入院时更高的NIHSS评分（20与15；P=0.001）。MMI的预测指标按敏感性和特异性分别如下：ADC<80%>82 mL，87%，91%；TTP>+4s>162 mL，83%，75%；TTP/ADC错配率<2.4，80%，79%；ADCcore<300 mm2/s，83%，85%；rADClesion<0.62，79%，74%；以及入院时NIHSS评分≥19，96%，72%。
对早期DWI和PWI参数进行定量分析能够预测MMI，并有助于选择适合积极组织保护治疗的患者。
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