快速自动化患者选择再灌注治疗：Echoplanar 成像溶栓评估试验（EPITHET）和弥散与灌注成像评估了解卒中演变（DEFUSE）研究的汇总分析。
RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study.
机构信息
Stanford University,Stanford Stroke Center, 780 Welch Road, Suite 205, Palo Alto, CA 94304, USA.
出版信息
Stroke. 2011 Jun;42(6):1608-14. doi: 10.1161/STROKEAHA.110.609008. Epub 2011 Apr 14.
BACKGROUND AND PURPOSE
The aim of this study was to determine if automated MRI analysis software (RAPID) can be used to identify patients with stroke in whom reperfusion is associated with an increased chance of good outcome.
METHODS
Baseline diffusion- and perfusion-weighted MRI scans from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution study (DEFUSE; n=74) and the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET; n=100) were reprocessed with RAPID. Based on RAPID-generated diffusion-weighted imaging and perfusion-weighted imaging lesion volumes, patients were categorized according to 3 prespecified MRI profiles that were hypothesized to predict benefit (Target Mismatch), harm (Malignant), and no effect (No Mismatch) from reperfusion. Favorable clinical response was defined as a National Institutes of Health Stroke Scale score of 0 to 1 or a ≥ 8-point improvement on the National Institutes of Health Stroke Scale score at Day 90.
RESULTS
In Target Mismatch patients, reperfusion was strongly associated with a favorable clinical response (OR, 5.6; 95% CI, 2.1 to 15.3) and attenuation of infarct growth (10 ± 23 mL with reperfusion versus 40 ± 44 mL without reperfusion; P<0.001). In Malignant profile patients, reperfusion was not associated with a favorable clinical response (OR, 0.74; 95% CI, 0.1 to 5.8) or attenuation of infarct growth (85 ± 74 mL with reperfusion versus 95 ± 79 mL without reperfusion; P=0.7). Reperfusion was also not associated with a favorable clinical response (OR, 1.05; 95% CI, 0.1 to 9.4) or attenuation of lesion growth (10 ± 15 mL with reperfusion versus 17 ± 30 mL without reperfusion; P=0.9) in No Mismatch patients.
CONCLUSIONS
MRI profiles that are associated with a differential response to reperfusion can be identified with RAPID. This supports the use of automated image analysis software such as RAPID for patient selection in acute stroke trials.
背景与目的
本研究旨在确定自动 MRI 分析软件（RAPID）是否可用于识别那些再灌注后具有良好预后获益可能性增加的卒中患者。
方法
来自弥散和灌注成像评估卒中演变研究（DEFUSE；n=74）和磁共振弥散加权成像与灌注加权成像不匹配预测急性缺血性卒中患者接受溶栓治疗结局的多中心、前瞻性、随机对照研究（EPITHET；n=100）的基线弥散加权成像和灌注加权成像扫描数据通过 RAPID 进行重新处理。基于 RAPID 生成的弥散加权成像和灌注加权成像病变体积，患者根据 3 种预设的 MRI 特征进行分类，这些特征假设可以预测再灌注的获益（不匹配靶区）、损害（恶性）和无效应（无不匹配）。临床预后良好定义为 NIHSS 评分 0-1 分或 NIHSS 评分较基线至少降低 8 分。
结果
在不匹配靶区患者中，再灌注与良好的临床预后（OR，5.6；95%CI，2.1 至 15.3）和梗死体积增长衰减（再灌注组为 10 ± 23 mL，无再灌注组为 40 ± 44 mL；P<0.001）强烈相关。在恶性特征患者中，再灌注与良好的临床预后（OR，0.74；95%CI，0.1 至 5.8）或梗死体积增长衰减（再灌注组为 85 ± 74 mL，无再灌注组为 95 ± 79 mL；P=0.7）均不相关。在无不匹配患者中，再灌注与良好的临床预后（OR，1.05；95%CI，0.1 至 9.4）或病变增长衰减（再灌注组为 10 ± 15 mL，无再灌注组为 17 ± 30 mL；P=0.9）均不相关。
结论
可通过 RAPID 识别与再灌注后反应差异相关的 MRI 特征。这支持在急性卒中试验中使用 RAPID 等自动图像分析软件进行患者选择。
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