Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Int J Stroke. 2012 Jun;7(4):282-8. doi: 10.1111/j.1747-4949.2011.00705.x. Epub 2011 Dec 8.
We analyzed early diffusion-weighted magnetic resonance imaging of patients with acute basilar artery occlusion by applying different lesion scoring systems and determined their predictive value for favorable outcome.
Between 1998 and 2010, patients with confirmed basilar artery occlusion were entered in a local database. magnetic resonance imaging angiography was performed for diagnosis of basilar artery occlusion and/or during initiated recanalization therapy. We analyzed the patients' clinical and radiological baseline data, recanalization, and favorable outcome modified Rankin Scale 0-2 after three-months. Diffusion weighted imaging findings were categorized into lesions in vascular territories as well as by two previously published scores for ischemic damage in the posterior circulation, the Renard score and posterior circulation Acute Stroke Prognosis Early computed tomography Score.
Fifty patients with basilar artery occlusion received an early MRI, and in 30 of those, a follow-up MRI was performed. Median time to baseline MRI was 5·5 h (one-hour to 24 h). Median baseline Renard score and posterior circulation Acute Stroke Prognosis Early CT Score were 2·75 (0-10) and 7 (0-10), respectively. Of the patients, 82% received an acute recanalization therapy and in 78% of those, the basilar artery recanalized. Median time to therapy was five-hours (1·25-20 h). 24% of all patients had a favorable outcome (mRS 0-2). Patients with a favorable outcome had a lower Renard score and higher pcASPECTS, a lower rate of complete basilar artery occlusion, a higher Glasgow coma scale on admission, and a higher rate of successful recanalization (all P < 0·05). After logistic regression, the only independent predictor for favorable outcome was a posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points (odds ratio 3·9, 95% confidence interval 1·4-11·7, P < 0·05).
In patients with acute basilar artery occlusion, posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points on early diffusion weighted imaging is an independent predictor for favorable outcome.
通过应用不同的病变评分系统，我们分析了急性基底动脉闭塞患者的早期弥散加权磁共振成像，并确定了它们对良好预后的预测价值。
1998 年至 2010 年间，将确诊为基底动脉闭塞的患者纳入当地数据库。磁共振血管造影用于诊断基底动脉闭塞和/或在开始的再通治疗期间进行。我们分析了患者的临床和影像学基线数据、再通情况以及三个月后的改良 Rankin 量表 0-2 的良好预后。弥散加权成像结果分为血管区域病变以及两种以前发表的后循环缺血损伤评分，即 Renard 评分和后循环急性卒中预后早期 CT 评分。
50 例基底动脉闭塞患者接受了早期 MRI，其中 30 例进行了随访 MRI。基线 MRI 的中位时间为 5.5 小时（1 小时至 24 小时）。中位基线 Renard 评分和后循环急性卒中预后早期 CT 评分分别为 2.75（0-10）和 7（0-10）。82%的患者接受了急性再通治疗，其中 78%的患者基底动脉再通。治疗的中位时间为 5 小时（1.25-20 小时）。所有患者中有 24%的预后良好（mRS 0-2）。预后良好的患者 Renard 评分较低，pcASPECTS 较高，基底动脉完全闭塞率较低，入院时格拉斯哥昏迷量表评分较高，再通成功率较高（均 P<0.05）。逻辑回归后，良好预后的唯一独立预测因子是后循环急性卒中预后早期 CT 评分 8 分或以上（优势比 3.9，95%置信区间 1.4-11.7，P<0.05）。
在急性基底动脉闭塞患者中，早期弥散加权成像上的后循环急性卒中预后早期 CT 评分 8 分或以上是良好预后的独立预测因子。
