Inoue Manabu, Mlynash Michael, Christensen Soren, Wheeler Hayley M, Straka Matus, Tipirneni Aaryani, Kemp Stephanie M, Zaharchuk Greg, Olivot Jean-Marc, Bammer Roland, Lansberg Maarten G, Albers Gregory W
From the Stanford Stroke Center, Stanford University School of Medicine, CA.
Stroke. 2014 Apr;45(4):1024-8. doi: 10.1161/STROKEAHA.113.002135. Epub 2014 Feb 20.
The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient.
MRI with DWI perfusion imaging was performed before (DWI 1) and within 12 hours after (DWI 2) endovascular treatment; follow-up MRI was obtained on day 5. Both DWIs were coregistered to follow-up MRI. Early DWI reversal was defined as the volume of the DWI 1 lesion that was not superimposed on the DWI 2 lesion. Permanent reversal was the volume of the DWI 1 lesion not superimposed on the day 5 infarct volume. Associations between early DWI reversal and clinical outcomes in patients with and without reperfusion were assessed.
A total of 110 patients had technically adequate DWI before endovascular therapy (performed median [interquartile range], 4.5 [2.8-6.2] hours after onset); 60 were eligible for this study. Thirty-two percent had early DWI reversal >10 mL; 17% had sustained reversal. The median volume of permanent reversal at 5 days was 3 mL (interquartile range, 1.7-7.0). Only 2 patients (3%) had a final infarct volume that was smaller than their baseline DWI lesion. Early DWI reversal was not an independent predictor of clinical outcome and was not associated with early reperfusion.
Early DWI reversal occurred in about one third of patients after endovascular therapy; however, reversal was often transient and was not associated with a significant volume of tissue salvage or favorable clinical outcome.
本研究旨在评估血管内治疗后早期弥散加权成像（DWI）病变逆转的频率和程度，并确定早期逆转是持续性的还是短暂性的。
在血管内治疗前（DWI 1）和治疗后12小时内（DWI 2）进行DWI灌注成像的MRI检查；在第5天进行随访MRI检查。将两个DWI图像与随访MRI图像进行配准。早期DWI逆转定义为DWI 1病变中未与DWI 2病变重叠的体积。永久性逆转是指DWI 1病变中未与第5天梗死体积重叠的体积。评估有或无再灌注患者的早期DWI逆转与临床结局之间的关联。
共有110例患者在血管内治疗前技术上有足够的DWI图像（发病后中位[四分位间距]时间为4.5[2.8 - 6.2]小时）；60例符合本研究条件。32%的患者早期DWI逆转>10 mL；17%的患者有持续性逆转。第5天永久性逆转的中位体积为3 mL（四分位间距，1.7 - 7.0）。只有2例患者（3%）最终梗死体积小于其基线DWI病变体积。早期DWI逆转不是临床结局的独立预测因素，且与早期再灌注无关。
血管内治疗后约三分之一的患者出现早期DWI逆转；然而，逆转通常是短暂的，且与大量组织挽救或良好的临床结局无关。
