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Stroke. 2013 Jan;44(1):73-9. doi: 10.1161/STROKEAHA.112.670034. Epub 2012 Dec 11.
Objective imaging methods to identify optimal candidates for late recanalization therapies are needed. The study goals were (1) to develop magnetic resonance imaging (MRI) and computed tomography (CT) multiparametric, voxel-based predictive models of infarct core and penumbra in acute ischemic stroke patients, and (2) to develop patient-level imaging criteria for favorable penumbral pattern based on good clinical outcome in response to successful recanalization.
An analysis of imaging and clinical data was performed on 2 cohorts of patients (one screened with CT, the other with MRI) who underwent successful treatment for large vessel, anterior circulation stroke. Subjects were divided 2:1 into derivation and validation cohorts. Pretreatment imaging parameters independently predicting final tissue infarct and final clinical outcome were identified.
The MRI and CT models were developed and validated from 34 and 32 patients, using 943 320 and 1 236 917 voxels, respectively. The derivation MRI and 2-branch CT models had an overall accuracy of 74% and 80%, respectively, and were independently validated with an accuracy of 71% and 79%, respectively. The imaging criteria of (1) predicted infarct core ≤90 mL and (2) ratio of predicted infarct tissue within the at-risk region ≤70% identified patients as having a favorable penumbral pattern with 78% to 100% accuracy.
Multiparametric voxel-based MRI and CT models were developed to predict the extent of infarct core and overall penumbral pattern status in patients with acute ischemic stroke who may be candidates for late recanalization therapies. These models provide an alternative approach to mismatch in predicting ultimate tissue fate.
需要客观的影像学方法来识别适合晚期再通治疗的最佳患者。研究目的为：(1) 建立急性缺血性脑卒中患者基于磁共振成像（MRI）和计算机断层扫描（CT）的多参数、体素预测梗死核心和半暗带的模型；(2) 根据成功再通后良好的临床转归，建立基于良好半暗带模式的患者水平影像学标准。
对 2 组接受大血管、前循环卒中成功治疗的患者（一组采用 CT 筛查，另一组采用 MRI）的影像学和临床数据进行分析。患者被 2:1 分为推导和验证队列。确定了独立预测最终组织梗死和最终临床结局的预处理影像学参数。
MRI 和 CT 模型分别在 34 例和 32 例患者中进行了开发和验证，使用了 943 320 个和 1 236 917 个体素。推导的 MRI 和 2 分支 CT 模型的总体准确率分别为 74%和 80%，分别独立验证的准确率为 71%和 79%。（1）预测梗死核心≤90 mL 和（2）预测风险区域内梗死组织的比例≤70%的影像学标准可以识别出具有良好半暗带模式的患者，准确率为 78%至 100%。
建立了多参数体素 MRI 和 CT 模型，以预测急性缺血性脑卒中患者梗死核心的范围和整体半暗带模式状态，这些患者可能是晚期再通治疗的候选者。这些模型为预测最终组织命运提供了一种替代不匹配的方法。
