Luby Marie, Warach Steven J, Nadareishvili Zurab, Merino José G
From the Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L., S.J.W., Z.N., J.G.M.); Department of Neurology and Neurotherapeutics, Seton/University of Texas Southwestern, Austin (S.J.W.); and Johns Hopkins Community Physicians, Bethesda, MD (Z.N., J.G.M.).
Stroke. 2014 Nov;45(11):3275-9. doi: 10.1161/STROKEAHA.114.006082. Epub 2014 Sep 11.
We hypothesize that reversal in diffusion-weighted imaging (DWI) volume at 24 hours predicts favorable clinical outcome only if accompanied by immediate reperfusion. Our aim was to quantify the immediate DWI and mean transit time changes at 2 and 24 hours after intravenous tissue-type plasminogen activator to evaluate the effect of reperfusion and DWI change on outcome.
Patients were selected from the Lesion Evolution in Stroke and Ischemia On Neuroimaging Project if they had an acute MRI with evaluable DWI and perfusion-weighted imaging, were treated with standard intravenous tissue-type plasminogen activator, had post-thrombolysis MRI with evaluable DWI and perfusion-weighted imaging at 2 and 24 hours and had follow-up fluid attenuated inversion recovery MRI at discharge through 90 days. A reader measured the DWI, mean transit time, and fluid attenuated inversion recovery volumes using a validated technique. A vascular neurologist scored the National Institutes of Health Stroke Scale at admit, 2, and 24 hours and the modified Rankin Scale at discharge, 5, 30, and 90 days. Favorable clinical outcome was defined as modified Rankin Scale of 0 or 1.
Seventy-one patients met the study criteria with mean (±SD) age of 71.6 (±16.4) years, 58% women, median admit National Institutes of Health Stroke Scale 9 (interquartile range, 4-18), median onset to triage 45 minutes (30-65), and median first MRI to intravenous tissue-type plasminogen activator 47 minutes (39-59). In binary multiple logistic regression analysis, younger age (odds ratio, 1.165; P=0.014; 95% confidence interval [CI], 1.031-1.316), lower admit National Institutes of Health Stroke Scale (odds ratio, 1.221; P=0.012; 95% confidence interval, 1.045-1.427), decrease in mean transit time volume at 2 hours (odds ratio, 1.021; P=0.031; 95% confidence interval, 1.002-1.040), and decrease in DWI volume at 24 hours (odds ratio, 1.173; P=0.027; 95% confidence interval, 1.018-1.351) were significant predictors of favorable clinical outcome.
Reversal of the DWI volume at 24 hours because of immediate reperfusion in patients post thrombolysis is predictive of favorable clinical outcome.
我们假设，仅当伴有即刻再灌注时，24小时弥散加权成像（DWI）体积的逆转才能预测良好的临床结局。我们的目的是量化静脉注射组织型纤溶酶原激活剂后2小时和24小时的即刻DWI及平均通过时间变化，以评估再灌注和DWI变化对结局的影响。
从“卒中与缺血性神经影像病变演变项目”中选取患者，这些患者需具备可评估DWI和灌注加权成像的急性MRI，接受标准静脉组织型纤溶酶原激活剂治疗，溶栓后2小时和24小时有可评估DWI和灌注加权成像的MRI，且出院时直至90天有随访的液体衰减反转恢复MRI。一名阅片者使用经过验证的技术测量DWI、平均通过时间和液体衰减反转恢复体积。一名血管神经科医生在入院时、2小时和24小时对美国国立卫生研究院卒中量表进行评分，并在出院时、5天、30天和90天对改良Rankin量表进行评分。良好的临床结局定义为改良Rankin量表评分为0或1。
71例患者符合研究标准，平均（±标准差）年龄为71.6（±16.4）岁，女性占58%，入院时美国国立卫生研究院卒中量表中位数为9（四分位间距，4 - 18），发病至分诊中位数为45分钟（30 - 65），首次MRI至静脉注射组织型纤溶酶原激活剂中位数为47分钟（39 - 59）。在二元多因素逻辑回归分析中，年龄较小（比值比，1.165；P = 0.014；95%置信区间[CI]，1.031 - 1.316）、入院时美国国立卫生研究院卒中量表较低（比值比，1.221；P = 0.012；95%置信区间，1.045 - 1.427）、2小时时平均通过时间体积减小（比值比，1.021；P = 0.031；95%置信区间，1.002 - 1.040）以及24小时时DWI体积减小（比值比，1.173；P = 0.027；95%置信区间，1.018 - 1.351）是良好临床结局的显著预测因素。
溶栓后患者因即刻再灌注导致的24小时DWI体积逆转可预测良好的临床结局。
