Son Jeong Pyo, Lee Mi Ji, Kim Suk Jae, Chung Jong-Won, Cha Jihoon, Kim Gyeong-Moon, Chung Chin-Sang, Lee Kwang Ho, Bang Oh Young
Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon, Korea.
J Stroke. 2017 Jan;19(1):88-96. doi: 10.5853/jos.2016.00955. Epub 2016 Dec 12.
Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, using magnetic resonance perfusion (MRP) techniques.
Consecutive patients who were candidates for recanalization therapy and underwent serial diffusion-weighted imaging (DWI) and MRP were enrolled. A collateral flow map derived from MRP source data was generated by automatic post-processing. The impact of a target mismatch (max>6 s/apparent diffusion coefficient (ADC) volume≥1.8, ADC volume<70 mL; and max>10 s for ADC volume<100 mL) on infarct growth was compared with MR-based collateral grading on day 7 DWI, using multivariate linear regression analysis.
Among 73 patients, 55 (75%) showed a target mismatch, whereas collaterals were poor in 14 (19.2%), intermediate in 36 (49.3%), and good in 23 (31.5%) patients. After adjusting for initial severity of stroke, early recanalization (<0.001) and the MR-based collateral grading (=0.001), but not the presence of a target mismatch, were independently associated with infarct growth. Even in patients with a target mismatch and successful recanalization, the degree of infarct growth depended on the collateral status. Perfusion status at later max time points (beyond the arterial phase) was more closely correlated with collateral status.
Patients with good collaterals show a favorable outcome in terms of infarct growth, regardless of the presence of a target mismatch pattern. The presence of slow blood filling predicts collateral status and infarct growth.
已对灌注-扩散不匹配进行评估，以确定目标不匹配的存在是否有助于识别对再通治疗反应良好的患者。我们使用磁共振灌注（MRP）技术比较了侧支循环状态和半暗带的存在对梗死灶生长的影响。
纳入连续的再通治疗候选患者，这些患者接受了系列扩散加权成像（DWI）和MRP检查。通过自动后处理从MRP源数据生成侧支血流图。使用多变量线性回归分析，将目标不匹配（最大>6秒/表观扩散系数（ADC）体积≥1.8，ADC体积<70 mL；ADC体积<100 mL时最大>10秒）对梗死灶生长的影响与第7天DWI时基于磁共振的侧支循环分级进行比较。
73例患者中，55例（75%）显示目标不匹配，而14例（19.2%）患者侧支循环较差，36例（49.3%）患者侧支循环中等，23例（31.5%）患者侧支循环良好。在调整了初始卒中严重程度、早期再通（<0.001）和基于磁共振的侧支循环分级（=0.001）后，与梗死灶生长独立相关的是早期再通和基于磁共振的侧支循环分级，而非目标不匹配的存在。即使在目标不匹配且成功再通的患者中，梗死灶生长程度也取决于侧支循环状态。后期最大时间点（超过动脉期）的灌注状态与侧支循环状态的相关性更强。
无论是否存在目标不匹配模式，侧支循环良好的患者在梗死灶生长方面预后良好。血流缓慢充盈的存在可预测侧支循环状态和梗死灶生长。
