Bivard Andrew, Cheng Xin, Lin Long-Ting, Levi Christopher, Spratt Neil, Kleinig Tim, O'Brien Billy, Butcher Kenneth, Lou Min, Zhang Jing-Fen, Sylaja P N, Cao Wen-Jie, Jannes Jim, Dong Qiang, Parsons Mark
Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
CNS Neurosci Ther. 2016 Mar;22(3):238-43. doi: 10.1111/cns.12491. Epub 2016 Jan 18.
Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis.
We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis.
Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h.
Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R(2) = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R(2) = 0.341, P = 0.034), very low CBV volume (R(2) = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R(2) = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001).
White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.
磁共振成像（MRI）上白质高信号（WMH）的出现是脑小血管病的一个标志，与小血管性卒中增加以及溶栓后出血转化（HT）风险增加相关。
我们试图确定灌注CT（CTP）上的白质灌注不足（WMHP）是否与WMH相关，以及WMHP是否易导致急性腔隙性卒中亚型和溶栓后的HT。
2011年至2013年期间，前瞻性招募了2个中心症状发作12小时内的急性缺血性卒中患者，纳入国际卒中灌注成像注册研究。参与者常规接受基线CT成像，包括CTP，并在24小时时进行MRI随访成像。
在229例缺血性卒中患者中，108例为白种人，121例为中国人。在对侧白质中，与其他卒中亚型患者相比，急性腔隙性卒中患者的脑血流量（CBF）和脑血容量（CBV）较低（P = 0.041）。有46例发生HT的患者，WMHP与HT风险增加相关（R² = 0.417，P = 0.002）。与先前报道的HT预测指标相比，WMHP的表现优于梗死核心体积（R² = 0.341，P = 0.034）、极低CBV体积（R² = 0.249，P = 0.026）和严重延迟灌注（Tmax>14秒，R² = 0.372，P = 0.011）。与无WMHP的患者相比，有WMHP的患者急性梗死灶也更大且梗死灶增长增加（平均28 mL对13 mL，P < 0.001）。
CTP上急性缺血区域远处的白质灌注不足是小血管病的一个标志，与HT增加、急性梗死核心更大以及梗死灶增长更大相关。
