Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neursciences, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex 14, France.
Stroke. 2012 Nov;43(11):2986-91. doi: 10.1161/STROKEAHA.112.661009. Epub 2012 Sep 20.
In acute stroke, diffusion-weighted imaging (DWI) lesions are commonly considered markers of irreversible ischemia yet can occasionally reverse. However, the extent and clinical correlates of DWI reversal in thrombolyzed patients remain unclear. We assessed the extent of reversible acute DWI lesions (RADs) and their relationships with clinical outcome in patients thrombolyzed≤4.5 hours from onset.
Data were retrospectively analyzed. RAD was defined as an acute DWI lesion not part of a 24-hour DWI lesion as determined voxelwise. Associations with an early neurological improvement (early neurological improvement=ΔNational Institutes of Health Stroke Scale≥8 or National Institutes of Health Stroke Scale≤2 at 24 hours) or an excellent outcome (modified Rankin Scale≤1) were assessed in multivariate analyses.
One hundred seventy-six patients were included. The median (interquartile range) time to treatment from onset was 150 minutes (120-194). Eighty-nine patients (50%) exhibited visually-detectable RAD irrespective of its extent. Over the whole population, the median percentage and volume of RAD were 11% (4-36) and 2.4 mL (0.5-8). Subtracting RAD from initial DWI altered perfusion-weighted imaging-DWI classification in 5 of 100 patients (shift from "no mismatch" to "mismatch" profile in all). Percent RAD was significantly greater in patients treated≤3 hours (P=0.049), without proximal occlusion (P=0.003), and in 24-hour recanalizers (P<0.001). Early neurological improvement was independently associated with percent RAD. This association increased with percent RAD split in quartiles in a "dose-dependent" manner (P for trend=0.01). Excellent outcome was independently associated with percent RAD (P for trend<0.001).
DWI reversal was often sizeable in patients treated≤4.5 hours. It was strongly associated with, albeit not necessarily causal for, early neurological improvement.
在急性脑卒中患者中，弥散加权成像（DWI）病灶通常被认为是不可逆性缺血的标志物，但偶尔也会逆转。然而，溶栓治疗患者的 DWI 逆转程度及其与临床转归的关系尚不清楚。我们评估了溶栓治疗≤4.5 小时发病的患者中急性 DWI 可逆性病灶（RAD）的程度及其与临床转归的关系。
对数据进行了回顾性分析。RAD 定义为根据体素确定的急性 DWI 病灶中不属于 24 小时 DWI 病灶的部分。采用多变量分析评估与早期神经功能改善（早期神经功能改善=Δ国立卫生研究院卒中量表≥8 分或 24 小时时国立卫生研究院卒中量表≤2 分）或良好结局（改良 Rankin 量表≤1 分）的相关性。
共纳入 176 例患者。从发病到治疗的中位（四分位数间距）时间为 150 分钟（120-194 分钟）。89 例（50%）患者存在视觉上可检测到的 RAD，而不管其程度如何。在整个人群中，RAD 的中位数百分比和体积分别为 11%（4-36）和 2.4 毫升（0.5-8.0 毫升）。从初始 DWI 中减去 RAD 改变了 100 例患者中的 5 例患者的灌注加权成像-DWI 分类（所有患者均从“无不匹配”转变为“不匹配”特征）。治疗≤3 小时的患者 RAD 百分比明显更大（P=0.049），无近端闭塞（P=0.003），24 小时再通患者 RAD 百分比明显更大（P<0.001）。早期神经功能改善与 RAD 百分比独立相关。这种相关性随着 RAD 百分比的四分位数增加而呈“剂量依赖性”增加（趋势 P=0.01）。良好结局与 RAD 百分比独立相关（趋势 P<0.001）。
溶栓治疗≤4.5 小时的患者 DWI 逆转程度通常较大。它与早期神经功能改善密切相关，但不一定是因果关系。
