Stroke Center, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
J Neurol Sci. 2012 May 15;316(1-2):99-103. doi: 10.1016/j.jns.2012.01.015. Epub 2012 Feb 11.
Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis.
We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was <8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was >14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis.
Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P<0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P=0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P=0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P=0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm(3) for mRS 2-6; 15.87 cm(3) for mRS 3-6; and 14.11 cm(3) in responder analysis.
Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.
缺血性病灶的增长可能是临床结果的替代标志物，但溶栓后的这种相互关系尚未确定。我们评估了弥散加权成像（DWI）上的早期梗死生长与溶栓后长期临床结果之间的关联。
我们回顾性分析了接受静脉组织型纤溶酶原激活剂或动脉内尿激酶治疗的急性大脑中动脉区域卒中患者的结局。在基线和 7 天内测量 DWI 病变体积，并计算差值。使用改良 Rankin 量表（mRS）在 3 个月时评估临床结局。良好和不良临床结局定义为：a）mRS 0-1 与 mRS 2-6，b）mRS 0-2 与 mRS 3-6，和 c）应答者分析，受基线国立卫生研究院卒中量表（NIHSS）评分影响：如果基线 NIHSS 评分<8，则 mRS 0 与 mRS 1-6 为良好和不良结局，如果 NIHSS 评分为 8-14，则 mRS 0-1 与 mRS 2-6 为良好和不良结局，NIHSS 评分>14，则 mRS 0-2 与 mRS 3-6 为良好和不良结局。探讨了缺血性病灶体积变化与临床结局的关系。使用受试者工作特征分析估计预测长期结局的梗死生长的截断值。
在 81 例患者中，67 例（82.7%）显示病灶生长，绝对生长与不良结局显著相关（所有 mRS 2-6、mRS 3-6 和应答者分析的 P<0.001）。多变量分析显示，绝对病灶生长是不良结局的独立预测因素，定义为 mRS 2-6（P=0.002；优势比[OR]，1.06；95%置信区间[CI]，1.02-1.10）、mRS 3-6（P=0.001；OR，1.06；95% CI，1.02-1.10）和应答者分析中的不良结局（P=0.001；OR，1.06；95% CI，1.03-1.10）。区分良好和不良结局的病灶生长的截断值为 mRS 2-6 为 14.11 cm(3)；mRS 3-6 为 15.87 cm(3)；应答者分析为 14.11 cm(3)。
早期 DWI 病灶生长是溶栓后不良结局的独立预测因素，可能是急性卒中试验中临床结局的潜在替代标志物。
