Robarts Research Institute, University of Western Ontario, London, Ont, Canada; Department of Medical Imaging, Odette Cancer Centre, and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5.
Radiology. 2013 Oct;269(1):240-8. doi: 10.1148/radiol.13122327. Epub 2013 May 28.
To assess the predictive value of reperfusion indices, recanalization, and important baseline clinical and radiologic scores for good clinical outcome prediction.
The study was approved by the local research ethics board. Written consent was obtained from all participants or their caregivers. Baseline computed tomography (CT) perfusion less than 4.5 hours after stroke symptoms, follow-up CT perfusion at 24 hours or less, and 5-7-day magnetic resonance images were obtained for 114 patients. Baseline imaging was assessed blinded to outcome. Recanalization status was determined at follow-up CT angiography. Reperfusion index was calculated on baseline and on follow-up at-risk tissue volume. Kruskal-Wallis, Mann-Whitney rank sum, and Spearman correlation were used for group comparisons and correlation studies. Univariate and multivariate logistic regression tested the association of clinical and imaging parameters with good outcome. Models with and without recanalization and reperfusion were compared by using Akaike information criterion.
Reperfusion indices were significantly higher in patients with recanalization than in those without (P < .001). Despite significance of recanalization at univariate analysis, only reperfusion, age, and National Institutes of Health Stroke Scale score were significant after multivariate analysis (P < .01). Time to maximum reperfusion index had the highest accuracy (area under the receiver operating characteristic curve, 0.70) for good outcome, and reperfusion was defined as time to maximum volume of 59% or greater. Patients with reperfusion but no recanalization had significantly lower total infarct volume (P = .001) and infarct growth (P = .004) and had higher salvaged penumbra (P = .009) volumes than patients without reperfusion and recanalization. A final model with reperfusion but not recanalization was the most prognostic model of good clinical outcome.
Reperfusion showed stronger association with good clinical outcome than did recanalization.
评估再灌注指数、再通和重要基线临床和影像学评分对良好临床结局预测的预测价值。
本研究获得了当地研究伦理委员会的批准。所有参与者或其照护者均书面同意参加。114 例患者在中风症状后 4.5 小时内进行基线计算机断层扫描（CT）灌注，24 小时内或更短时间内进行随访 CT 灌注，并在 5-7 天内进行磁共振成像。基线成像结果在不知道结局的情况下进行评估。通过随访 CT 血管造影确定再通状态。在基线和随访时计算再灌注指数在风险组织的体积。采用 Kruskal-Wallis、Mann-Whitney 秩和检验和 Spearman 相关系数进行组间比较和相关性研究。单变量和多变量逻辑回归检验了临床和影像学参数与良好结局的关系。使用赤池信息量准则比较了有再通和无再通的模型。
再灌注指数在再通患者中明显高于无再通患者（P<0.001）。尽管再通在单变量分析中有统计学意义，但只有再灌注、年龄和美国国立卫生研究院卒中量表评分在多变量分析中具有统计学意义（P<0.01）。最大再灌注指数的时间具有最佳的准确性（受试者工作特征曲线下面积，0.70），良好的结果定义为 59%或更大的最大体积再灌注。与无再灌注和再通的患者相比，有再灌注但无再通的患者的总梗死体积（P=0.001）和梗死生长（P=0.004）显著降低，而挽救的半影区体积（P=0.009）显著升高。只有再灌注而没有再通的最终模型是预测良好临床结局的最具预后模型。
再灌注与良好的临床结局的相关性强于再通。
