Kimura Kazumi, Iguchi Yasuyuki, Shibazaki Kensaku, Watanabe Masao, Iwanaga Takeshi, Aoki Junya
Stroke. 2009 Sep;40(9):3130-2. doi: 10.1161/STROKEAHA.109.552588. Epub 2009 Jun 25.
In acute stroke patients treated with intravenous tissue plasminogen activator (t-PA), early recanalization of occluded arteries can improve the clinical outcome. The magnetic susceptibility effect of deoxygenated hemoglobin in red thrombi can present as hypointense signals on T2*-weighted gradient echo imaging. We investigated whether the gradient echo imaging M1 susceptibility vessel sign (M1 SVS) can predict no early recanalization after t-PA infusion.
Patients with internal carotid artery and M1 occlusion were prospectively studied. MRI studies, including DWI, T2*, and MRA, were performed before and within 30 minutes and 24 hours after t-PA infusion. The NIHSS score was obtained before and 7 days after t-PA administration. The relationship between the presence of the M1 SVS and no early recanalization and patient outcome was examined.
A total of 48 patients (29 men; mean age, 74.6+/-11.2 years) were enrolled. M1 SVS was present in 13 (27.1%) patients and absent in 35 (72.9%) patients. There were no significant differences in clinical characteristics between the 2 groups. Follow-up MRA within 30 minutes after t-PA infusion revealed that 20 (57.1%) of the 35 patients without the M1 SVS had early recanalization, but that none of the 13 patients with the M1 SVS had early recanalization (P=0.0002). Seven days after t-PA infusion, dramatic improvement was more frequently observed in patients without the M1 SVS (51.4%) than in those with the M1 SVS (0%, P=0.0007).
The M1 SVS on T2* appears to be a strong predictor for no early recanalization after t-PA therapy.
在接受静脉注射组织型纤溶酶原激活剂（t-PA）治疗的急性卒中患者中，闭塞动脉的早期再通可改善临床预后。红色血栓中脱氧血红蛋白的磁敏感性效应在T2*加权梯度回波成像上可表现为低信号。我们研究了梯度回波成像M1敏感性血管征（M1 SVS）是否可预测t-PA输注后无早期再通。
对颈内动脉和M1段闭塞的患者进行前瞻性研究。在t-PA输注前、输注后30分钟内及24小时内进行MRI检查，包括弥散加权成像（DWI）、T2*加权成像和磁共振血管造影（MRA）。在t-PA给药前和给药后7天获得美国国立卫生研究院卒中量表（NIHSS）评分。研究M1 SVS的存在与无早期再通及患者预后之间的关系。
共纳入48例患者（29例男性；平均年龄74.6±11.2岁）。13例（27.1%）患者存在M1 SVS，35例（72.9%）患者不存在M1 SVS。两组患者的临床特征无显著差异。t-PA输注后30分钟内的随访MRA显示，35例无M1 SVS的患者中有20例（57.1%）出现早期再通，但13例有M1 SVS的患者均未出现早期再通（P=0.0002）。t-PA输注7天后，无M1 SVS的患者（51.4%）比有M1 SVS的患者（0%，P=0.0007）更常观察到显著改善。
T2*加权成像上的M1 SVS似乎是t-PA治疗后无早期再通的有力预测指标。
