Yu Songlin, Liebeskind David S, Dua Sumit, Wilhalme Holly, Elashoff David, Qiao Xin J, Alger Jeffry R, Sanossian Nerses, Starkman Sidney, Ali Latisha K, Scalzo Fabien, Lou Xin, Yoo Bryan, Saver Jeffrey L, Salamon Noriko, Wang Danny J J
Department of Neurology, UCLA, Los Angeles, California, USA.
Department of Radiology, UCLA, Los Angeles, California, USA.
J Cereb Blood Flow Metab. 2015 Mar 31;35(4):630-7. doi: 10.1038/jcbfm.2014.238.
The purpose of this study was to investigate the relationship between hyperperfusion and hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Pseudo-continuous arterial spin labeling (ASL) with background suppressed 3D GRASE was performed during routine clinical magnetic resonance imaging (MRI) on AIS patients at various time points. Arterial spin labeling cerebral blood flow (CBF) maps were visually inspected for the presence of hyperperfusion. Hemorrhagic transformation was followed during hospitalization and was graded on gradient recalled echo (GRE) scans into hemorrhagic infarction (HI) and parenchymal hematoma (PH). A total of 361 ASL scans were collected from 221 consecutive patients with middle cerebral artery stroke from May 2010 to September 2013. Hyperperfusion was more frequently detected posttreatment (odds ratio (OR) = 4.8, 95% confidence interval (CI) 2.5 to 8.9, P < 0.001) and with high National Institutes of Health Stroke Scale (NIHSS) scores at admission (P<0.001). There was a significant association between having hyperperfusion at any time point and HT (OR = 3.5, 95% CI 2.0 to 6.3, P < 0.001). There was a positive relationship between the grade of HT and time-hyperperfusion with the Spearman's rank correlation of 0.44 (P = 0.003). Arterial spin labeling hyperperfusion may provide an imaging marker of HT, which may guide the management of AIS patients post tissue-type plasminogen activator (tPA) and/or endovascular treatments. Late hyperperfusion should be given more attention to prevent high-grade HT.
本研究的目的是调查急性缺血性卒中（AIS）患者中高灌注与出血性转化（HT）之间的关系。在不同时间点对AIS患者进行常规临床磁共振成像（MRI）检查时，采用背景抑制三维快速自旋回波（3D GRASE）的伪连续动脉自旋标记（ASL）技术。通过肉眼检查动脉自旋标记脑血流量（CBF）图，以确定是否存在高灌注。在住院期间对出血性转化情况进行随访，并在梯度回波（GRE）扫描上对其进行分级，分为出血性梗死（HI）和脑实质血肿（PH）。2010年5月至2013年9月期间，共收集了221例连续的大脑中动脉卒中患者的361次ASL扫描数据。治疗后更频繁地检测到高灌注（优势比（OR）=4.8，95%置信区间（CI）2.5至8.9，P<0.001），且入院时美国国立卫生研究院卒中量表（NIHSS）评分较高（P<0.001）。在任何时间点出现高灌注与HT之间存在显著关联（OR = 3.5，95% CI 2.0至6.3，P < 0.001）。HT分级与时间-高灌注之间存在正相关关系，Spearman等级相关系数为0.44（P = 0.003）。动脉自旋标记高灌注可能提供HT的影像学标志物，这可能指导组织型纤溶酶原激活剂（tPA）和/或血管内治疗后AIS患者的管理。应更加关注晚期高灌注，以预防高级别HT。
