Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
J Neurol Sci. 2011 May 15;304(1-2):35-9. doi: 10.1016/j.jns.2011.02.024. Epub 2011 Mar 12.
The present study investigated the relationship between serial changes in ischemic lesion volume (ILV) and neurological recovery after t-PA therapy.
A total of 110 consecutive patients with ICA and MCA occlusion on MRA treated with t-PA within 3 h of onset were prospectively studied. MRI including MRA, DWI, and FLAIR, was performed before, 1 h, 24 h, and 7 days after t-PA infusion to measure serial changes in ILV.
The mean (SD) values of ILV at baseline, 1 h, 24 h, and 7 days after t-PA infusion were 30.2 (61.0), 48.1 (76.3), 98.3 (125.3), and 125.9 (149.8) cm(3), respectively. Recovery at 7 days was remarkable in 46 patients and good in 21 patients. Change in NIHSS score (baseline NIHSS minus NIHSS at 7 days) correlated with ΔILV (ILV at 7 days minus baseline ILV) (r=0.611, P<0.0001). Sensitivity and specificity curve analysis demonstrated that a cutoff value for ΔILV of 40 cm(3) (sensitivity, 80.0%; specificity, 79.3%) indicated remarkable recovery, and that 80 cm(3) (78.8% and 76.3%) indicated good recovery.
The thresholds of ΔILV enlargement for remarkable and good recovery after t-PA therapy were 40 and 80 cm(3), respectively.
本研究旨在探讨 t-PA 治疗后缺血性病灶体积（ILV）的连续变化与神经功能恢复之间的关系。
前瞻性研究了 110 例 MRA 显示 ICA 和 MCA 闭塞并在发病后 3 小时内接受 t-PA 治疗的患者。在 t-PA 输注前后 1 小时、24 小时和 7 天进行 MRI，包括 MRA、DWI 和 FLAIR，以测量 ILV 的连续变化。
基线、t-PA 输注后 1 小时、24 小时和 7 天时的 ILV 平均值（标准差）分别为 30.2（61.0）、48.1（76.3）、98.3（125.3）和 125.9（149.8）cm3。7 天时 46 例患者显著恢复，21 例患者恢复良好。NIHSS 评分变化（基线 NIHSS 减去 7 天时的 NIHSS）与ΔILV（7 天时的 ILV 减去基线 ILV）相关（r=0.611，P<0.0001）。敏感性和特异性曲线分析表明，ΔILV 为 40 cm3（敏感性 80.0%，特异性 79.3%）提示显著恢复，80 cm3（78.8%和 76.3%）提示恢复良好。
t-PA 治疗后显著和良好恢复的ΔILV 增大阈值分别为 40 和 80 cm3。
