Department of Neurology, Busan-Ulsan Regional Cardio-Cerebrovascular Diseases Center, Chang-Won Samsung Medical Center, Dong-A University Hospital, Republic of Korea.
Eur Neurol. 2011;65(5):257-63. doi: 10.1159/000324727. Epub 2011 Apr 4.
Recent research has suggested that a perfusion-weighted image (PWI) relative cerebral blood volume (rCBV) map after acute ischemic stroke (AIS) provides information about the collateral circulation in the ischemic region. In this study, we demonstrate the usefulness of the rCBV ratio in PWI in predicting poor outcome after using IV t-PA in AIS. We recruited 58 stroke patients who were treated with IV t-PA after diagnostic magnetic resonance imaging (MRI). Poor outcome was defined as a Modified Rankin Scale (mRS) score >2 measured 90 days after ischemic insult. In total, 21 patients (36.2%) demonstrated poor outcome (i.e. mRS score 3-6). Poor outcome after t-PA correlated with age (p = 0.03), serum glucose level (p = 0.01), NIHSS (p = 0.05), and the presence of T-occlusion (p = 0.05). Poor outcome also correlated with diffusion-weighted MR images of the lesion volume (p < 0.01), lower rCBV ratio on PWI (p < 0.01), and non-recanalization (p < 0.01). Among these, non-recanalization (p < 0.01), reduced rCBV ratio on PWI (p < 0.01), age (p = 0.04), and serum glucose level (p = 0.01) had an independent significance for predicting it. This suggests that the rCBV ratio on PWI may be used to determine prognosis after thrombolysis in AIS.
近期研究表明，急性缺血性脑卒中（AIS）后灌注加权成像（PWI）相对脑血容量（rCBV）图可提供有关缺血区域侧支循环的信息。在这项研究中，我们展示了 PWI 中 rCBV 比值在预测 AIS 中使用 IV t-PA 后不良结局的有用性。我们招募了 58 名接受 IV t-PA 治疗的中风患者，这些患者均经过诊断性磁共振成像（MRI）检查。不良结局定义为缺血性损伤后 90 天时改良 Rankin 量表（mRS）评分>2。共有 21 名患者（36.2%）表现出不良结局（即 mRS 评分 3-6）。t-PA 治疗后的不良结局与年龄（p = 0.03）、血清葡萄糖水平（p = 0.01）、NIHSS（p = 0.05）和 T 型闭塞（p = 0.05）相关。不良结局还与病变体积的弥散加权 MR 图像相关（p < 0.01）、PWI 上 rCBV 比值较低（p < 0.01）和未再通相关（p < 0.01）。在这些因素中，未再通（p < 0.01）、PWI 上 rCBV 比值降低（p < 0.01）、年龄（p = 0.04）和血清葡萄糖水平（p = 0.01）对预测结果具有独立意义。这表明 PWI 上的 rCBV 比值可用于确定 AIS 溶栓后的预后。
