Chen Chia-Yuen, Chen Chin-I, Tsai Fong Y, Tsai Ping-Huei, Chan Wing P
Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
PLoS One. 2015 Jun 25;10(6):e0131118. doi: 10.1371/journal.pone.0131118. eCollection 2015.
Predicting the risk of further infarct growth in stroke patients is critical to therapeutic decision making. We aimed to predict early infarct growth and clinical outcome from prominent vessel sign (PVS) identified on the first susceptibility-weighted image (SWI) after acute stroke.
Twenty-two patients with middle cerebral artery (MCA) infarction had diffusion-weighted imaging, SWI, MR angiography, and clinical evaluation using the National Institutes of Health Stroke Scale at 7-60 hours and 5-14 days after stroke onset. Late-stage clinical evaluation at 1 and 3 months used the modified Rankin Scale. The infarct area and growth were scored from 10 (none) to 0 (infarct or growth in all 10 zones) using the Alberta Stroke Program Early CT Score (ASPECTS) system.
Infarct growth on the second MRI occurred in 13 of 15 patients with PVS on the first MRI and not in any patient without PVS (n=7; r=0.86, P<0.001). The extent of PVS was significantly correlated with infarct growth (r=0.82, P<0.001) and early-stage outcome (P=0.02). No between-group difference in late-stage clinical outcome was found.
PVS on the first SWI after acute MCA territory stroke is a useful predictor of early infarct growth. Extensive PVS within the large MCA territory is related to poor early-stage outcome and could be useful for clinical assessment of stroke.
预测卒中患者进一步梗死灶扩大的风险对治疗决策至关重要。我们旨在根据急性卒中后首次磁敏感加权成像（SWI）上识别出的显著血管征（PVS）来预测早期梗死灶扩大及临床结局。
22例大脑中动脉（MCA）梗死患者在卒中发作后7 - 60小时及5 - 14天接受了弥散加权成像、SWI、磁共振血管造影检查，并使用美国国立卫生研究院卒中量表进行临床评估。在1个月和3个月时进行晚期临床评估，采用改良Rankin量表。使用阿尔伯塔卒中项目早期CT评分（ASPECTS）系统将梗死面积和扩大程度从10分（无）到0分（所有10个区域均有梗死或扩大）进行评分。
15例首次MRI上有PVS的患者中，13例在第二次MRI上出现梗死灶扩大，而7例无PVS的患者均未出现梗死灶扩大（r = 0.86，P < 0.001）。PVS的范围与梗死灶扩大（r = 0.82，P < 0.001）及早期结局（P = 0.02）显著相关。晚期临床结局在组间未发现差异。
急性MCA区域卒中后首次SWI上的PVS是早期梗死灶扩大的有用预测指标。大脑中动脉大区域内广泛的PVS与早期不良结局相关，对卒中的临床评估可能有用。
