From the Center for Stroke Research (K.V., A.-C.O., U.G., P.B., A.A.K., K.S., O.E., H.A., J.B.F.), Department of Biostatistics and Clinical Epidemiology (U.G.), NeuroCure Cluster of Excellence (A.A.K.), and Department of Neurology (H.A.), Charite-Universitätsmedizin, Berlin, Germany; and Department of Neurology and Stroke Center (B.E.S.C.), La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonomous University of Madrid, Spain.
Neurology. 2017 Jan 31;88(5):433-440. doi: 10.1212/WNL.0000000000003566. Epub 2016 Dec 28.
To quantitatively evaluate blood-brain barrier changes in ischemic stroke patients using dynamic contrast-enhanced (DCE) MRI.
We examined 54 stroke patients (clinicaltrials.gov NCT00715533, NCT02077582) in a 3T MRI scanner within 48 hours after symptom onset. Twenty-eight patients had a follow-up examination on day 5-7. DCE T1 mapping and Patlak analysis were employed to assess BBB permeability changes.
Median stroke K values (0.7 × 10 min [interquartile range (IQR) 0.4-1.8] × 10 min) were more than 3-fold higher compared to median mirror K values (0.2 × 10 min, IQR 0.1-0.7 × 10 min, p < 0.001) and further increased at follow-up (n = 28, 2.3 × 10 min, IQR 0.8-4.6 × 10 min, p < 0.001). By contrast, mirror K values decreased over time with a clear interaction of timepoint and stroke/mirror side (p < 0.001). Median stroke K values were 2.5 times lower than in hemorrhagic transformed regions (0.7 vs 1.8 × 10 min; p = 0.055). There was no association between stroke K values and the delay from symptom onset to baseline examination, age, and presence of hyperintense acute reperfusion marker.
BBB in acute stroke patients can be successfully assessed quantitatively. The decrease of BBB permeability in unaffected regions at follow-up may be an indicator of global BBB leakage even in vessel territories remote from the index infarct.
利用动态对比增强（DCE）MRI 定量评估缺血性脑卒中患者的血脑屏障变化。
我们在症状发作后 48 小时内对 54 名脑卒中患者（clinicaltrials.gov NCT00715533，NCT02077582）进行了 3T MRI 扫描检查。28 名患者在第 5-7 天进行了随访检查。采用 DCE T1 映射和 Patlak 分析评估 BBB 通透性变化。
与中位数镜像 K 值（0.2 × 10 min，IQR 0.1-0.7 × 10 min，p < 0.001）相比，中位数中风 K 值（0.7 × 10 min，IQR 0.4-1.8 × 10 min）高出 3 倍以上，并且在随访时进一步升高（n = 28，2.3 × 10 min，IQR 0.8-4.6 × 10 min，p < 0.001）。相比之下，镜像 K 值随时间而降低，并且存在时间点和中风/镜像侧之间的明显交互作用（p < 0.001）。中风 K 值比出血性转化区域低 2.5 倍（0.7 与 1.8 × 10 min；p = 0.055）。中风 K 值与症状发作至基线检查的时间延迟、年龄和急性再灌注高信号标志物的存在之间无相关性。
可以成功对急性脑卒中患者的 BBB 进行定量评估。在随访时未受影响区域的 BBB 通透性降低可能是即使在远离指数梗死的血管区域也存在全局 BBB 渗漏的指标。
