Department of Neurology, Samsung Medical Center, Seoul, South Korea.
Cerebrovasc Dis. 2010;29(1):87-94. doi: 10.1159/000256653. Epub 2009 Nov 10.
Recently, the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) and the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) trialists suggested that diffusion-perfusion magnetic resonance imaging (MRI) can classify patients into 4 subgroups likely to differentially experience benefit or harm from reperfusion therapies. However, there is a lack of data comparing MR mismatch profiles between different race-ethnic groups. In addition, clinical factors affecting MR mismatch profiles are not well described.
We analyzed clinical and pretreatment MRI data of patients from 2 geographically and ethnically distinct study populations (Seoul, South Korea, and Los Angeles, Calif., USA) who are eligible for recanalization therapy. Diffusion-perfusion mismatch regions were classified among the 4 DEFUSE MR profiles: target mismatch, no mismatch, small lesion and malignant.
A total of 147 South Korean and 162 Southern Californian subjects (64.2% Whites) were included. Pretreatment MRIs revealed that the MR mismatch profiles were different in the 2 study populations (p < 0.001). Target mismatch was more prevalent in Southern Californian subjects (67.9%) compared with South Korean subjects (58.5%), whereas the small lesion pattern was more prevalent in the latter (9.9 vs. 23.1%). After adjusting for covariables, 3 features independently decreased the likelihood of presence of target mismatch: history of diabetes (OR 0.369, 95% CI 0.196-0.694), small versus large arterial occlusion (OR 0.052, 95% CI 0.01-0.255) and largest size (highest tertile) of diffusion-weighted imaging (DWI) lesion volume (OR 0.516, 95% CI 0.266-0.999). The one feature independently increasing target mismatch likelihood was intermediate size (middle tertile) DWI volume (OR 2.977, 95% CI 1.431-6.195).
Target mismatch profiles are present in 55-70% of patients. Target mismatch is less common in patients with diabetes, small vessel occlusion, Asian ethnicity and extensive DWI lesions, and more common in patients with DWI lesions of intermediate size.
最近，扩散和灌注成像评估用于了解中风演变（DEFUSE）和磁共振弥散加权成像及灌注成像在急性缺血性脑卒中溶栓治疗中的应用研究（EPITHET）试验的研究者们提出，弥散-灌注磁共振成像（MRI）可以将患者分为 4 个亚组，这些亚组可能会因再灌注治疗而不同程度地受益或受到伤害。然而，目前缺乏不同种族亚组之间磁共振失配特征比较的数据。此外，影响磁共振失配特征的临床因素也没有得到很好的描述。
我们分析了来自两个地理位置和种族截然不同的研究人群（韩国首尔和美国加利福尼亚州洛杉矶）的符合再通治疗条件的患者的临床和治疗前 MRI 数据。弥散-灌注失配区域被分为 DEFUSE 磁共振 4 种 Profile：靶匹配、无失配、小病灶和恶性。
共纳入 147 名韩国人和 162 名南加州受试者（64.2%为白人）。治疗前 MRI 显示，这两个研究人群的磁共振失配特征不同（p<0.001）。靶匹配在南加州受试者中更为常见（67.9%），而在韩国受试者中则较少见（58.5%），而小病灶模式在后者更为常见（9.9%对 23.1%）。在调整协变量后，3 个特征独立降低了靶匹配的可能性：糖尿病史（OR 0.369，95%CI 0.196-0.694）、小动脉闭塞与大血管闭塞（OR 0.052，95%CI 0.01-0.255）和弥散加权成像（DWI）病变体积最大（最高三分位）（OR 0.516，95%CI 0.266-0.999）。一个特征独立增加靶匹配可能性的是中等大小（中间三分位）DWI 体积（OR 2.977，95%CI 1.431-6.195）。
靶匹配特征存在于 55-70%的患者中。糖尿病、小血管闭塞、亚洲人种和广泛的 DWI 病变使靶匹配的发生几率降低，而 DWI 病变的中等大小使靶匹配的发生几率增加。
