Wanamaker C P, Fakhran S, Alhilali L M
From the Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
AJNR Am J Neuroradiol. 2015 Jun;36(6):1063-8. doi: 10.3174/ajnr.A4232. Epub 2015 Feb 5.
Mesenchymal stem cells have potential as a regenerative therapy in ischemic stroke. We sought to determine MR imaging findings after mesenchymal stem cell implantation in chronic middle cerebral artery infarcts and to compare brain volume changes in patients with mesenchymal stem cells with those in age-matched healthy controls and controls with chronic stable MCA infarcts.
We retrospectively identified 5 patients receiving surgical mesenchymal stem cell implantation to an MCA infarct from January 1, 2005, to July 1, 2013, with MR imaging immediately and 1 year postimplantation. Images at both time points were evaluated for any postimplantation complications. Structural image evaluation using normalization of atrophy software was used to determine volume changes between time points and compare them with those in healthy and age- and sex-matched controls with chronic, stable MCA infarcts by using Kruskal-Wallis and Mann-Whitney U tests.
Susceptibility signal loss and enhancement at the implantation site were seen. No teratoma, tumor, or heterotopia was identified. Volumetric analysis showed a trend toward less overall volume loss after mesenchymal stem cell implantation (0.736; 95% CI, -4.15-5.62) compared with that in age- and sex-matched controls with chronic, stable MCA infarcts (-3.59; 95% CI, -12.3 to -5.21; P = .09), with a significantly greater growth-to-loss ratio in infarcted regions (1.30 and 0.78, respectively, P = .02). A trend toward correlation of growth-to-loss ratio with improvement in physical examination findings was seen (r = 0.856, P = .06).
Postoperative changes consistent with stereotactic implantation were seen, but no teratoma, tumor, or heterotopia was identified. Initial findings suggest a trend toward less volume loss after mesenchymal stem cell implantation compared with that in age- and sex-matched controls with chronic, stable MCA infarcts, with a significantly greater growth-to-loss ratio in the infarcted tissue.
间充质干细胞在缺血性卒中的再生治疗中具有潜力。我们试图确定间充质干细胞植入慢性大脑中动脉梗死灶后的磁共振成像表现，并比较间充质干细胞治疗患者与年龄匹配的健康对照以及慢性稳定大脑中动脉梗死对照的脑容量变化。
我们回顾性纳入了2005年1月1日至2013年7月1日期间接受大脑中动脉梗死灶间充质干细胞手术植入的5例患者，在植入后即刻及1年时进行磁共振成像检查。评估两个时间点的图像以查找任何植入后并发症。使用萎缩归一化软件进行结构图像评估，以确定时间点之间的体积变化，并通过Kruskal-Wallis和Mann-Whitney U检验将其与年龄、性别匹配的慢性稳定大脑中动脉梗死的健康对照进行比较。
在植入部位可见磁敏感信号丢失和强化。未发现畸胎瘤、肿瘤或异位组织。体积分析显示，与年龄、性别匹配的慢性稳定大脑中动脉梗死对照相比，间充质干细胞植入后总体积丢失有减少趋势（0.736；95%CI，-4.15至5.62）（-3.59；95%CI，-12.3至-5.21；P = 0.09），梗死区域的生长与丢失比显著更高（分别为1.30和0.78，P = 0.02）。生长与丢失比与体格检查结果改善之间存在相关趋势（r = 0.856，P = 0.06）。
可见与立体定向植入一致的术后改变，但未发现畸胎瘤、肿瘤或异位组织。初步结果表明，与年龄、性别匹配的慢性稳定大脑中动脉梗死对照相比，间充质干细胞植入后体积丢失有减少趋势，梗死组织的生长与丢失比显著更高。
