Niibo Takeya, Ohta Hajime, Miyata Shirou, Ikushima Ichiro, Yonenaga Kazuchika, Takeshima Hideo
From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
Stroke. 2017 Jan;48(1):117-122. doi: 10.1161/STROKEAHA.116.013923. Epub 2016 Dec 1.
Arterial spin-labeling magnetic resonance imaging is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke. We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in acute ischemic stroke patients.
In a retrospective study, arterial spin-labeling was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline magnetic resonance angiography. All patients underwent angiographic procedures intended for endovascular therapy and a noncontrast computed tomography scan immediately after treatment. BBB disruption was defined as a hyperdense lesion present on the posttreatment computed tomography scan. A subacute magnetic resonance imaging or computed tomography scan was performed during the subacute phase to assess HTs. The relationship between HLs and BBB disruption and HT was examined using the Alberta Stroke Program Early Computed Tomography Score locations in the symptomatic hemispheres.
A HL was defined as a region where CBF≥1.4 (CBF=CBF/CBF). HLs, BBB disruption, and HT were found in 9, 15, and 15 patients, respectively. Compared with the patients without HLs, the patients with HLs had a higher incidence of both BBB disruption (100% versus 37.5%; P=0.003) and HT (100% versus 37.5%; P=0.003). Based on the Alberta Stroke Program Early Computed Tomography Score locations, 21 regions of interests displayed HLs. Compared with the regions of interests without HLs, the regions of interests with HLs had a higher incidence of both BBB disruption (42.8% versus 3.9%; P<0.001) and HT (85.7% versus 7.8%; P<0.001).
HLs detected on pretreatment arterial spin-labeling maps may enable the prediction and localization of subsequent BBB disruption and HT.
动脉自旋标记磁共振成像对检测急性缺血性脑卒中患者的充血性病变（HLs）较为敏感。我们评估了HLs是否能够预测急性缺血性脑卒中患者的血脑屏障（BBB）破坏及出血性转化（HT）。
在一项回顾性研究中，对25例在基线磁共振血管造影显示前循环大血管闭塞的患者，在血管再通治疗前症状发作6小时内进行动脉自旋标记。所有患者均接受了旨在进行血管内治疗的血管造影检查，并在治疗后立即进行非增强计算机断层扫描。BBB破坏定义为治疗后计算机断层扫描上出现的高密度病变。在亚急性期进行亚急性磁共振成像或计算机断层扫描以评估HTs。使用阿尔伯塔卒中项目早期计算机断层扫描评分在症状性半球的位置来检查HLs与BBB破坏及HT之间的关系。
HL定义为脑血流量（CBF）≥1.4的区域（CBF = 病变脑血流量/对侧脑血流量）。分别在9例、15例和1例患者中发现了HLs、BBB破坏和HT。与无HLs的患者相比，有HLs的患者BBB破坏（100%对37.5%；P = 0.003）和HT（100%对37.5%；P = 0.003）的发生率均更高。基于阿尔伯塔卒中项目早期计算机断层扫描评分的位置，21个感兴趣区域显示有HLs。与无HLs的感兴趣区域相比，有HLs的感兴趣区域BBB破坏（42.8%对3.9%；P < 0.001）和HT（85.7%对7.8%；P < 0.001）的发生率均更高。
治疗前动脉自旋标记图上检测到的HLs可能有助于预测和定位随后的BBB破坏及HT。
