Kaya Dilaver, Dincer Alp, Arman Fehim, Bakirci Nadi, Erzen Canan, Pamir M Necmettin
Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey.
Department of Radiology, Acibadem University School of Medicine, Istanbul, Turkey.
Int J Stroke. 2015 Dec;10(8):1277-83. doi: 10.1111/j.1747-4949.2011.00640.x. Epub 2011 Oct 4.
The location of the primary motor cortex can be detected in healthy adults using the findings of 'T2 hypointensity' and the 'double layer sign' on 3 T diffusion-weighted imaging. The aim of this study was to assess whether ischemic involvement of the primary motor cortex can be identified on 3 T diffusion-weighted imaging within six-hours after stroke onset and to evaluate whether this finding could predict clinical outcome three-months after ischemic stroke.
Sixty-five patients who had paralysis and ischemia of the anterior circulation underwent 3 T magnetic resonance imaging within six-hours of symptom onset. Follow-up MRI was obtained at 72 h. Anatomic localization and ischemic involvement of the primary motor cortex were evaluated on diffusion-weighted imaging by two investigators. Ischemic involvement on the primary motor cortex was classified into three grades. Ischemic lesion volumes were measured. We compared the favorable outcomes at three-months between subjects with and without ischemic involvement on the primary motor cortex using the NIHSS and modified Rankin Scale.
Ischemic involvement on the primary motor cortex was identified in 52% of patients. Interrater agreement coefficients were 0·93 for the identification of ischemic involvement of primary motor cortex. As defined by scores on the modified Rankin Scale, among the patients with ischemic involvement of the primary motor cortex were worse than the patients without ischemic involvement of the primary motor cortex (P = 0·01). The mean ischemic lesion volume at baseline diffusion-weighted imaging was 38·7 ± 41·7 cm(3) and was 89·8 ± 93·6 cm(3) at follow-up T2-WI. Ischemic involvement on the primary motor cortex (odds ratio: 14·7) was a determinant for worse outcome.
3T diffusion-weighted imaging can identify ischemic involvement on the primary motor cortex and may provide useful information for predicting outcome during the hyperacute stage. Ischemic involvement on the primary motor cortex has a significant negative impact on recovery.
在健康成年人中，可利用3T扩散加权成像上的“T2低信号”和“双层征”来检测初级运动皮层的位置。本研究的目的是评估在卒中发作后6小时内，能否通过3T扩散加权成像识别初级运动皮层的缺血累及情况，并评估这一发现是否可预测缺血性卒中后3个月的临床结局。
65例出现前循环瘫痪和缺血的患者在症状发作后6小时内接受了3T磁共振成像检查。在72小时时进行了随访MRI检查。两名研究人员通过扩散加权成像评估初级运动皮层的解剖定位和缺血累及情况。初级运动皮层的缺血累及情况分为三个等级。测量了缺血性病变体积。我们使用美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表比较了初级运动皮层有缺血累及和无缺血累及的受试者在3个月时的良好结局。
52%的患者被发现有初级运动皮层的缺血累及。初级运动皮层缺血累及识别的组内相关系数为0.93。根据改良Rankin量表评分，初级运动皮层有缺血累及的患者比无缺血累及的患者情况更差（P = 0.01）。基线扩散加权成像时的平均缺血性病变体积为38.7±41.7 cm³，随访T2加权成像时为89.8±93.6 cm³。初级运动皮层的缺血累及（优势比：14.7）是预后较差的一个决定因素。
3T扩散加权成像可识别初级运动皮层的缺血累及情况，并可能为超急性期预测结局提供有用信息。初级运动皮层的缺血累及对恢复有显著负面影响。
