Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
AJNR Am J Neuroradiol. 2011 May;32(5):846-51. doi: 10.3174/ajnr.A2415. Epub 2011 Apr 7.
MR perfusion CBF values can distinguish hypoperfused penumbral tissue likely to infarct from that which is likely to recover. Our aim was to determine if CBF thresholds for tissue infarction depend on the timing of recanalization in patients with acute stroke treated with IAT.
Twenty-six patients with acute proximal anterior circulation strokes underwent DWI and PWI before IAT. rCBF was obtained in the following areas: 1) C with abnormal DWI, reduced CBF, follow-up infarction; 2) PI with normal DWI, reduced CBF, follow-up infarction and 3) PNI with normal DWI, reduced CBF, normal follow-up. rCBF in tissue reperfused at <6 hours (early recanalizers), in tissue reperfused at >6 hours (late RC), and in NRC was compared.
For C, mean rCBF was 0.13 (SEM, 0.002), 0.29 (0.007), and 0.21 (0.004) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001, for all comparisons). For PI, mean rCBF was 0.34 (0.006), 0.38 (0.008), and 0.39 (0.005) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001 for early-versus-late recanalizers and versus nonrecanalizers; P > .05 for late recanalizers versus nonrecanalizers). For PNI, the mean rCBF was 0.38 (0.002), 0.48 (0.003), and 0.48 (0.004) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001 for early-versus-late recanalizers and nonrecanalizers; P > .05 for late recanalizers versus nonrecanalizers). ROC analyzis demonstrated optimal rCBF thresholds for tissue infarction of 0.27 (sensitivity, 80%; specificity, 87%), 0.44 (sensitivity, 77%; specificity, 75%), and 0.41 (sensitivity, 78%; specificity, 77%) for early recanalizers, late recanalizers, and nonrecanalizers, respectively.
CBF thresholds for tissue infarction in patients with acute stroke are lower in tissue that is reperfused at earlier time points. This information may be important in selecting patients who might benefit from reperfusion therapy.
MR 灌注 CBF 值可区分可能梗死的低灌注半暗带组织与可能恢复的组织。我们的目的是确定急性卒中患者接受 IAT 治疗后，组织梗死的 CBF 阈值是否取决于再通的时间。
26 例急性近端前循环卒中患者在 IAT 前进行 DWI 和 PWI。在以下区域获得 rCBF：1）C 区有异常 DWI、降低的 CBF、随访性梗死；2）PI 区有正常 DWI、降低的 CBF、随访性梗死；3）PNI 区有正常 DWI、降低的 CBF、正常随访。比较再通时间<6 小时（早期再通者）、再通时间>6 小时（晚期再通者）和非再通者（NR）的 rCBF。
对于 C 区，早期再通者、晚期再通者和非再通者的平均 rCBF 分别为 0.13（SEM，0.002）、0.29（0.007）和 0.21（0.004）（P<0.001，均有统计学差异）。对于 PI 区，早期再通者、晚期再通者和非再通者的平均 rCBF 分别为 0.34（0.006）、0.38（0.008）和 0.39（0.005）（P<0.001，早期与晚期再通者、早期与非再通者之间有统计学差异；晚期与非再通者之间无统计学差异，P>0.05）。对于 PNI 区，早期再通者、晚期再通者和非再通者的平均 rCBF 分别为 0.38（0.002）、0.48（0.003）和 0.48（0.004）（P<0.001，早期与晚期再通者、早期与非再通者之间有统计学差异；晚期与非再通者之间无统计学差异，P>0.05）。ROC 分析显示，早期再通者、晚期再通者和非再通者的组织梗死最佳 rCBF 阈值分别为 0.27（敏感性 80%，特异性 87%）、0.44（敏感性 77%，特异性 75%）和 0.41（敏感性 78%，特异性 77%）。
急性卒中患者再通时间较早的组织中，组织梗死的 CBF 阈值较低。这些信息可能对选择可能从再灌注治疗中获益的患者很重要。
