Payabvash Seyedmehid, Taleb Shayandokht, Benson John C, Hoffman Benjamin, Oswood Mark C, McKinney Alexander M, Rykken Jeffrey B
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
Acta Radiol. 2017 Jul;58(7):876-882. doi: 10.1177/0284185116675658. Epub 2016 Oct 31.
Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.
背景 近期研究表明，急性缺血性脑卒中患者的磁敏感-扩散不匹配与灌注-扩散不匹配之间存在相关性。目的 确定大脑中动脉（MCA）区域急性缺血性脑卒中患者磁敏感-扩散不匹配的临床及影像学关联。材料与方法 纳入连续的MCA区域急性缺血性脑卒中患者，这些患者在症状发作或最后一次情况良好的时间24小时内接受了磁共振成像（MRI）检查，包括磁敏感加权成像（SWI）和扩散加权成像（DWI）。两名神经放射科医生对SWI扫描进行评估，以确定SWI-DWI不匹配，其定义为患侧半球SWI上区域血管数量或直径增加，超出DWI高信号区域。入院时的卒中严重程度采用美国国立卫生研究院卒中量表（NIHSS）评分进行评估。不良临床结局定义为3个月改良Rankin量表（mRS）评分>2。结果 本研究纳入的150例患者中，44例（29.3%）存在SWI-DWI不匹配。存在SWI-DWI不匹配的患者入院时梗死体积较小（31.2±44.7 vs 55.9±117.7 mL，P = 0.045）且年龄较轻（60.4±18.9 vs 67.1±15.5，P = 0.026）。在校正年龄、入院NIHSS评分和梗死体积后，使用倾向评分匹配法，SWI-DWI不匹配与不良临床结局发生率降低22.6%相关（P = 0.032）。在我们的队列中，溶栓治疗对结局无显著影响。结论 急性MCA区域缺血性梗死中SWI-DWI不匹配的存在与较小的梗死体积相关。此外，在校正梗死大小、入院症状严重程度和年龄后，SWI-DWI不匹配与更好的结局相关。
