Hillis A E, Gold L, Kannan V, Cloutman L, Kleinman J T, Newhart M, Heidler-Gary J, Davis C, Aldrich E, Llinas R, Gottesman R F
Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Meyer 6-113, 600 N Wolfe St, Baltimore, MD 21287, USA.
Neurology. 2008 Jul 15;71(3):184-9. doi: 10.1212/01.wnl.0000317091.17339.98.
Diffusion-perfusion mismatch has been used to estimate salvageable tissue and predict potential for recovery in acute stroke. Location of the salvageable tissue may be as important as volume or percentage in predicting potential for recovery of specific functions. Impaired naming, a common and disabling deficit after left hemisphere stroke, is often associated with tissue dysfunction of left Brodmann area (BA) 37, posterior inferior temporal cortex. We tested the hypothesis that the presence of diffusion-perfusion mismatch within left BA 37 predicts probability and extent of short-term improvement of naming.
One hundred five patients with acute left hemisphere ischemic stroke had diffusion-weighted imaging, perfusion-weighted imaging, a test of picture naming, and other language tests at admission and 2 to 4 days later. Linear regression was used to determine whether diffusion-perfusion mismatch in any BA in language cortex, total volume of mismatch, or diffusion or perfusion abnormality predicted degree of improvement in naming by days 3 to 5.
The presence of >20% diffusion-perfusion mismatch in left BA 37 and total volumes of diffusion and perfusion abnormality at day 1 each independently predicted degree of improvement in naming. Mismatch in this area did not predict the degree of improvement in other language tests or the NIH Stroke Scale in this study.
CONCLUSIONS/RELEVANCE: Diffusion-perfusion mismatch in left Brodmann area 37 was strongly associated with acute improvement in naming, independently of volume or percentage of total mismatch or diffusion or perfusion abnormality. These data indicate that mismatch in a particular area is a marker of salvageable tissue and an important predictor of potential for recovery of functions that depend on that area. Location of mismatch before treatment may help to predict potential benefits of reperfusion.
弥散灌注不匹配已被用于评估急性卒中可挽救组织并预测恢复潜力。在预测特定功能恢复潜力方面，可挽救组织的位置可能与体积或百分比同样重要。命名障碍是左半球卒中后常见且致残的缺陷，常与左侧布罗德曼区（BA）37（颞叶后下部皮质）的组织功能障碍相关。我们检验了以下假设：左侧BA 37内存在弥散灌注不匹配可预测命名短期改善的可能性及程度。
105例急性左半球缺血性卒中患者在入院时及2至4天后接受了弥散加权成像、灌注加权成像、图片命名测试及其他语言测试。采用线性回归来确定语言皮质中任何BA的弥散灌注不匹配、不匹配的总体积、弥散或灌注异常是否能预测第3至5天命名改善的程度。
左侧BA 37中弥散灌注不匹配>20%以及第1天弥散和灌注异常的总体积各自独立预测了命名改善的程度。在本研究中，该区域的不匹配并未预测其他语言测试或美国国立卫生研究院卒中量表的改善程度。
左侧布罗德曼区37的弥散灌注不匹配与命名的急性改善密切相关，独立于总体不匹配、弥散或灌注异常的体积或百分比。这些数据表明特定区域的不匹配是可挽救组织的标志，也是依赖该区域的功能恢复潜力的重要预测指标。治疗前不匹配的位置可能有助于预测再灌注的潜在益处。
