Aoki Junya, Kimura Kazumi, Shibazaki Kensaku, Saji Naoki, Uemura Junichi, Sakamoto Yuki, Nagai Koichiro
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
J Neurol Sci. 2015 Jan 15;348(1-2):195-200. doi: 10.1016/j.jns.2014.12.002. Epub 2014 Dec 8.
Half of acute stroke patients have poor outcomes at 3 months even when treated with intravenous thrombolysis using tissue-plasminogen activator (t-PA) therapy. The aim of the present study was to evaluate the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) T2* at the proximal portion of the middle cerebral artery (M1 proximal SVS) on clinical outcome in anterior circulation stroke patients treated with t-PA.
The presence of the M1 proximal SVS was assessed before t-PA therapy. Good outcome and poor outcome at 3 months were defined as a modified Rankin Scale score of 0 to 2 and 4 to 6, respectively. The predictive values of the M1 proximal SVS for a good and poor outcome were calculated.
161 patients (median age [interquartile], 76 [67-83] years; male, 91 [57%]) were enrolled. At 3 months after stroke, 68 (42%) patients achieved a good outcome, and 75 (47%) had a poor outcome. The M1 proximal SVS was found in 17 (11%) patients, of whom none (0%) achieved a good outcome, and 16 (94%) had a poor outcome. The sensitivity and positive predictive value of the M1 proximal SVS for good outcome were very low (0.000 and 0.000, respectively). Furthermore, the specificity and positive predictive value of the M1 proximal SVS for poor outcome were very high (0.988 and 0.941, respectively).
The M1 proximal SVS appears to be a strong predictor for poor outcome after t-PA therapy.
即使采用组织型纤溶酶原激活剂（t-PA）静脉溶栓治疗，仍有一半的急性中风患者在3个月时预后不佳。本研究的目的是评估大脑中动脉近端（M1近端）的磁共振成像（MRI）T2*上的易损血管征（SVS）对接受t-PA治疗的前循环中风患者临床结局的影响。
在t-PA治疗前评估M1近端SVS的存在情况。3个月时的良好结局和不良结局分别定义为改良Rankin量表评分为0至2分和4至6分。计算M1近端SVS对良好结局和不良结局的预测价值。
共纳入161例患者（中位年龄[四分位间距]，76[67 - 83]岁；男性91例[57%]）。中风后3个月，68例（42%）患者结局良好，75例（47%）患者结局不佳。17例（11%）患者发现有M1近端SVS，其中无一例（0%）结局良好，16例（94%）结局不佳。M1近端SVS对良好结局的敏感性和阳性预测值非常低（分别为0.000和0.000）。此外，M1近端SVS对不良结局的特异性和阳性预测值非常高（分别为0.988和0.941）。
M1近端SVS似乎是t-PA治疗后不良结局的有力预测指标。
