Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Chongwen District, China.
Acad Radiol. 2010 Dec;17(12):1506-17. doi: 10.1016/j.acra.2010.07.010.
To investigate whether baseline apparent diffusion coefficient (ADC) maps can be employed to predict both infarct core and salvageable ischemic tissue volumes in acute ischemic stroke.
An automated image analysis system based on baseline ADC maps was tested against 30 patients with acute ischemic stroke of anterior circulation to predict both infarct core and salvageable ischemic tissue volumes. The predicted infarct core and predicted salvageable ischemic tissue were quantitatively and qualitatively compared with follow-up imaging data in recanalization and no recanalization groups, respectively. Direct comparisons with perfusion- and diffusion- weighted magnetic resonance imaging measures were also made. Wilcoxon signed-rank test, Spearman rank correlation, and Bland-Altman plots were performed.
In the recanalization group, the predicted infarct core volume was significantly correlated with the final infarct volume (r = 0. 868, P < .001). In the no recanalization group, the predicted final infarct volume (sum of the predicted infarct core and salvageable ischemic tissue volumes), as well as the predicted salvageable ischemic tissue volume, was also significantly correlated with the true final infarct volume (r = 0.955, P < .001) and infarct growth (r = 0.918, P < .001), respectively. The volumes of perfusion-diffusion mismatch were significantly larger than those of infarct growth and predicted salvageable ischemic tissue. Good agreement between predicted and true final infarct lesions was visualized by Bland-Altman plots in two groups. Direct visual comparative analysis revealed good qualitative agreement between the true final infarct and predicted lesions in 21 patients.
The proposed ADC based approach may be a feasible and practical tool to predict the volumes of infarct core and salvageable ischemic tissue without intravenous contrast media-enhanced perfusion-weighted imaging at baseline.
研究是否可以使用基线表观扩散系数（ADC）图来预测急性缺血性脑卒中的梗死核心和可挽救的缺血组织体积。
使用基于基线 ADC 图的自动图像分析系统对 30 例前循环急性缺血性脑卒中患者进行测试，以预测梗死核心和可挽救的缺血组织体积。在再通组和未再通组中，分别将预测的梗死核心和预测的可挽救的缺血组织与随访的成像数据进行定量和定性比较。还与灌注加权和弥散加权磁共振成像测量值进行了直接比较。进行了 Wilcoxon 符号秩检验、Spearman 秩相关和 Bland-Altman 图分析。
在再通组中，预测的梗死核心体积与最终梗死体积显著相关（r = 0.868，P <.001）。在未再通组中，预测的最终梗死体积（预测的梗死核心和可挽救的缺血组织体积之和）以及预测的可挽救的缺血组织体积也与真实的最终梗死体积（r = 0.955，P <.001）和梗死生长（r = 0.918，P <.001）显著相关。灌注-弥散不匹配的体积明显大于梗死生长和预测的可挽救的缺血组织。在两组中，Bland-Altman 图可视化了预测的和真实的最终梗死病变之间的良好一致性。直接的视觉比较分析显示，在 21 例患者中，真实的最终梗死病变与预测的病变具有良好的定性一致性。
该研究提出的基于 ADC 的方法可能是一种可行且实用的工具，无需静脉内对比增强灌注加权成像即可预测梗死核心和可挽救的缺血组织的体积。
