Liu Yawu, Karonen Jari O, Vanninen Ritva L, Nuutinen Juho, Koskela Anna, Soimakallio Seppo, Aronen Hannu J
Department of Clinical Radiology, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland.
Radiology. 2004 May;231(2):517-27. doi: 10.1148/radiol.2312030565. Epub 2004 Mar 24.
To evaluate phase-contrast magnetic resonance (MR) angiography and diffusion- and perfusion-weighted imaging in predicting evolution of infarction and clinical outcome.
Phase-contrast angiographic and diffusion-weighted images obtained 1 and 2 days after acute middle cerebral artery (MCA) stroke were assessed in 43 patients; 39 underwent perfusion-weighted imaging on day 1. Follow-up phase-contrast angiographic and T2-weighted images (n = 38) were obtained on day 8. Clinical outcome was assessed at 3 months. Patients were assigned to three groups according to angiographic findings on day 1: group 1, absence of flow in proximal MCA (M1 segment); group 2, internal carotid artery (ICA) occlusion with collateral M1 flow; group 3, flow in ICA and M1. Differences in lesion volumes on diffusion- and perfusion-weighted maps among groups were compared with one-way analysis of variance with Tukey post hoc multiple comparisons.
Patients in group 1 had significantly larger infarct growth, volumes of hypoperfusion on relative cerebral blood volume (rCBV) and relative cerebral blood flow maps, and initial and final infarct volumes than did other patients (P <.05). Initial perfusion deficits on mean transit time maps were significantly (P =.002) larger in group 2 than in group 3, but there were no significant differences in infarct growth (P =.977), final infarct volume on day 8 (P =.947), and clinical outcome (P =.969). Absence of M1 flow on day 1 was significantly associated with unfavorable clinical outcome (modified Rankin score > or = 3) at 3 months (P =.010, chi(2) test). Discriminant analysis revealed that rCBV maps alone and combination of diffusion-weighted imaging and MR angiography yielded the highest accuracy in predicting an unfavorable clinical outcome.
Phase-contrast MR angiography can provide complementary information to that with diffusion- and perfusion- weighted imaging in predicting the outcome of patients with acute stroke.
评估相位对比磁共振（MR）血管造影以及扩散加权成像和灌注加权成像在预测梗死演变及临床预后方面的价值。
对43例急性大脑中动脉（MCA）卒中患者在发病1天和2天后获取的相位对比血管造影图像及扩散加权图像进行评估；其中39例在第1天进行了灌注加权成像。在第8天获取随访的相位对比血管造影图像及T2加权图像（n = 38）。在3个月时评估临床预后。根据第1天的血管造影结果将患者分为三组：第1组，MCA近端（M1段）无血流；第2组，颈内动脉（ICA）闭塞伴M1段侧支血流；第3组，ICA和M1段有血流。采用单因素方差分析及Tukey事后多重比较，比较各组间扩散加权图和灌注加权图上病变体积的差异。
与其他患者相比，第1组患者的梗死灶增长、相对脑血容量（rCBV）和相对脑血流量图上的低灌注体积以及初始和最终梗死灶体积均显著更大（P <.05）。第2组平均通过时间图上的初始灌注缺损显著（P =.002）大于第3组，但梗死灶增长（P =.977）、第8天的最终梗死灶体积（P =.947）及临床预后（P =.969）无显著差异。第1天M1段无血流与3个月时不良临床预后（改良Rankin评分≥3）显著相关（P =.010，χ²检验）。判别分析显示，单独的rCBV图以及扩散加权成像和MR血管造影的联合应用在预测不良临床预后方面具有最高的准确性。
在预测急性卒中患者的预后方面，相位对比MR血管造影可为扩散加权成像和灌注加权成像提供补充信息。
