Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, Japan.
Int J Stroke. 2013 Jul;8(5):321-6. doi: 10.1111/j.1747-4949.2012.00902.x. Epub 2012 Sep 27.
Recent studies have shown that thrombolysis could decrease or eliminate ischaemic diffusion-weighted imaging lesions. However, the features of such diffusion-weighted imaging lesion reduction are not well known.
To clarify, the frequency of and factors associated with lesion reduction were investigated.
Patients given intravenous tissue plasminogen activator therapy within three-hours of onset were prospectively enrolled. Magnetic resonance imaging including diffusion-weighted imaging and magnetic resonance angiography was performed four times: on admission, just after intravenous tissue plasminogen activator, 24 h from intravenous tissue plasminogen activator, and seven-days after intravenous tissue plasminogen activator. The diffusion-weighted imaging lesion volume was measured by manual trace using National Institutes of Health imaging software. All patients were divided into three groups according to the early diffusion-weighted imaging lesion volume change from admission to just after intravenous tissue plasminogen activator: the lesion reduction group (>20% decrease); the lesion growth group (>20% increase); and the lesion unchanged group.
In total, 105 patients [56 males, median age 77 (interquartile range 70-83) years, and National Institutes of Health Stroke Scale score 16 (10-22)] were enrolled. Early diffusion-weighted imaging lesion reduction was observed in seven (7%) patients. The decreased lesion increased subsequently. On multivariate analysis, the glucose level on admission (odds ratio 0·95, 95% confidence interval 0·91 to 0·99, P = 0·045) and early recanalization (odds ratio 15·7, 95% confidence interval 1·61 to 153, P = 0·018) were independently related to early lesion reduction.
Early diffusion-weighted imaging lesion reduction was observed in 7% of patients treated with intravenous tissue plasminogen activator. The decreased lesion increased subsequently. Initial glucose level and early recanalization were independently associated with early diffusion-weighted imaging lesion reduction.
近期研究表明溶栓治疗可以减少或消除缺血性弥散加权成像（DWI）病灶。然而，弥散加权成像病灶减少的特征尚不清楚。
为了阐明这一点，本研究旨在探讨病灶减少的频率和相关因素。
前瞻性纳入发病 3 小时内接受静脉组织型纤溶酶原激活物（tPA）治疗的患者。在发病后，患者接受了 4 次磁共振成像（MRI）检查，包括弥散加权成像和磁共振血管造影（MRA）：入院时、静脉 tPA 后即刻、静脉 tPA 后 24 小时、静脉 tPA 后 7 天。使用 NIH 影像学软件对 DWI 病灶体积进行手动描记测量。根据发病后至静脉 tPA 后即刻的早期 DWI 病灶体积变化，所有患者被分为 3 组：病灶减少组（减少>20%）、病灶进展组（增加>20%）和病灶未变组。
共纳入 105 例患者（56 例男性，中位年龄 77（70-83）岁，NIHSS 评分 16（10-22）分）。7 例（7%）患者出现早期 DWI 病灶减少。减少的病灶随后增加。多变量分析显示，入院时血糖水平（比值比 0.95，95%置信区间 0.91-0.99，P=0.045）和早期再通（比值比 15.7，95%置信区间 1.61-153，P=0.018）与早期病灶减少独立相关。
静脉 tPA 治疗的患者中观察到 7%出现早期 DWI 病灶减少。减少的病灶随后增加。初始血糖水平和早期再通与早期弥散加权成像病灶减少独立相关。
