Hillis A E, Wityk R J, Beauchamp N J, Ulatowski J A, Jacobs M A, Barker P B
Department of Cognitive Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Neuroradiology. 2004 Jan;46(1):31-9. doi: 10.1007/s00234-002-0918-4. Epub 2003 Dec 12.
We carried out baseline and short-term follow-up MRI, including perfusion-weighted imaging (PWI) and tests of neurologic and cognitive function on 15 consecutive patients with large-vessel ischemic stroke who showed a persistent large perfusion-diffusion mismatch at enrollment up to seven days after the onset of symptoms. Of these, ten underwent induced blood pressure elevation with phenylephrine and oral medications (in eight) or intravenous fluids (in two) with the goal of improving perfusion; five had no such treatment. Significant functional improvement was defined by a reduction of 3 or more points on the NIH stroke scale (NIHSS). Significant improvement in perfusion was defined by a reduction in the volume of hypoperfused brain by 30 cc on PWI using time-to-peak (TTP) maps, without enlargement of the infarct. There was a strong, statistically significant association between improved function and improved perfusion: six (75%) of eight patients who improved in function, but none of the seven who did not, showed a reduction in volume of hypoperfused brain. All six patients who met the perfusion goal, and only two (22%) of nine who did not showed significant functional improvement (Fisher's exact: P < 0.01). There were no differences between patients who improved functionally and those who did not with respect to age, initial volume of abnormality on DWI or PWI, initial NIHSS, or changes on DWI. These findings indicate that reduction in volume of hypoperfused brain on PWI is a marker of response to treatment to improve perfusion even in subacute stroke and that partial reperfusion of regions of salvageable but dysfunctional tissue is a mechanism of improved function associated with induced blood pressure elevation.
我们对15例连续的大血管缺血性卒中患者进行了基线和短期随访磁共振成像（MRI），包括灌注加权成像（PWI）以及神经和认知功能测试。这些患者在症状发作后长达7天的入组时显示出持续的大灌注-扩散不匹配。其中，10例患者接受了苯肾上腺素诱导的血压升高治疗，并联合口服药物（8例）或静脉输液（2例），目的是改善灌注；5例未接受此类治疗。显著的功能改善定义为美国国立卫生研究院卒中量表（NIHSS）评分降低3分或更多。灌注的显著改善定义为使用达峰时间（TTP）图的PWI显示灌注不足脑体积减少30 cc，且梗死灶无扩大。功能改善与灌注改善之间存在强烈的、具有统计学意义的关联：8例功能改善的患者中有6例（75%）显示灌注不足脑体积减少，而7例未改善的患者中无一例出现这种情况。所有达到灌注目标的6例患者，以及9例未达到目标的患者中只有2例（22%）显示出显著的功能改善（Fisher精确检验：P < 0.01）。在功能改善的患者与未改善的患者之间，在年龄、DWI或PWI上的初始异常体积、初始NIHSS或DWI上的变化方面没有差异。这些发现表明，即使在亚急性卒中中，PWI上灌注不足脑体积的减少也是对改善灌注治疗反应的一个标志，并且可挽救但功能失调组织区域的部分再灌注是与诱导血压升高相关的功能改善机制。
