Cheng Bastian, Schröder Nikolaus, Forkert Nils Daniel, Ludewig Peter, Kemmling André, Magnus Tim, Fiehler Jens, Gerloff Christian, Thomalla Götz
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N4N1, Canada.
J Neuroimaging. 2017 Jul;27(4):414-420. doi: 10.1111/jon.12417. Epub 2016 Dec 21.
The diagnostic value of susceptibility-weighted magnetic resonance imaging of acute stroke patients has shown potential as a surrogate marker of impaired hemodynamics. We investigate the value of asymmetrical hypointense cerebral vessels (HV) for the identification of vessel status and tissue at risk of infarction (TaR).
Symmetry of HV was visually rated on SWI data from a well-defined population of acute anterior circulation stroke with onset <24 hours. MRI perfusion data was analyzed and volumes of tissue at risk segmented using a delay threshold of Tmax> 6 seconds. Status of the extra- and intracranial arteries was assessed by ultrasound and MR angiography.
35 patients were included (12 women; median age 69 years, IQR 61-77; median NIHSS at admission 10, IQR 6-20). Asymmetrically distributed HV were detected at the stroke hemisphere in 25 patients (71%). Of those, 12 patients displayed occlusion of the middle cerebral artery, whereas occlusion of the extracranial ICA was detected in 6 patients. TaR was larger, yet not significantly different in patients with asymmetrically HV (mean volume 38.9 ml, SD 52.9 ml) compared to patients showing symmetrical HV (4.2 ml; SD 10.7 ml, p-value 0.081). Significant differences where, however, found after excluding patients with extracranial ICA occlusions (42.9 ml; SD 50.4 ml vs. 4.2 ml, SD 10.8 ml, p-value 0.025).
Visual analysis of HV in SWI identifies tissue at risk in patients with anterior circulation stroke. Potentially pre-existing extracranial ICA occlusions leading to prominent HV have to be considered as a confounding factor.
急性卒中患者的磁敏感加权磁共振成像的诊断价值已显示出作为血流动力学受损替代标志物的潜力。我们研究不对称低信号脑血管（HV）在识别血管状态和梗死风险组织（TaR）方面的价值。
对发病<24小时的明确的急性前循环卒中患者群体的SWI数据进行HV对称性的视觉评估。分析MRI灌注数据，并使用Tmax>6秒的延迟阈值分割梗死风险组织体积。通过超声和磁共振血管造影评估颅外和颅内动脉的状态。
纳入35例患者（12例女性；中位年龄69岁，四分位间距61 - 77岁；入院时中位NIHSS为10，四分位间距6 - 20）。25例患者（71%）在卒中半球检测到不对称分布的HV。其中，12例患者显示大脑中动脉闭塞，6例患者检测到颅外颈内动脉闭塞。与显示对称HV的患者（4.2 ml；标准差10.7 ml）相比，不对称HV患者的TaR更大，但无显著差异（平均体积38.9 ml，标准差52.9 ml，p值0.081）。然而，在排除颅外颈内动脉闭塞患者后发现了显著差异（42.9 ml；标准差50.4 ml对4.2 ml，标准差10.8 ml，p值0.025）。
SWI中HV的视觉分析可识别前循环卒中患者的梗死风险组织。必须将可能预先存在的导致显著HV 的颅外颈内动脉闭塞视为一个混杂因素。
