RAPID评估的灌注阈值对SWIFT PRIME（以血栓切除术为主要血管内治疗手段的Solitaire）最终梗死体积的预测价值
Predictive Value of RAPID Assessed Perfusion Thresholds on Final Infarct Volume in SWIFT PRIME (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment).
作者信息
Mokin Maxim, Levy Elad I, Saver Jeffrey L, Siddiqui Adnan H, Goyal Mayank, Bonafé Alain, Cognard Christophe, Jahan Reza, Albers Gregory W
机构信息
From the Department of Neurosurgery, University of South Florida, Tampa (M.M.); Department of Neurosurgery, University at Buffalo, NY (E.I.L., A.H.S.); Department of Neurology, David Geffen School of Medicine (J.L.S.) and Division of Interventional Neuroradiology (R.J.), University of California, Los Angeles; Departments of Radiology and Clinical Neurosciences, University of Calgary, Alberta, Canada (M.G.); Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France (A.B.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, France (C.C.); and Stanford Stroke Center, Stanford University School of Medicine, CA (G.W.A.).
出版信息
Stroke. 2017 Apr;48(4):932-938. doi: 10.1161/STROKEAHA.116.015472. Epub 2017 Mar 10.
BACKGROUND AND PURPOSE
Computed tomography perfusion imaging can estimate the size of the ischemic core, which can be used for the selection of patients for endovascular therapy. The relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) thresholds chosen to identify ischemic core influence the accuracy of prediction. We aimed to analyze the accuracy of various rCBV and rCBF thresholds for predicting the 27-hour infarct volume using RAPID automated analysis software from the SWIFT PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment) data.
METHODS
Patients from the SWIFT PRIME study who achieved complete reperfusion based on time until the residue function reached its peak >6 s perfusion maps obtained at 27 hours were included. Patients from both the intravenous tissue-type plasminogen activator only and endovascular groups were included in analysis. Final infarct volume was determined on magnetic resonance imaging (fluid-attenuated inversion recovery images) or computed tomography scans obtained 27 hours after symptom onset. The predicted ischemic core volumes on rCBV and rCBF maps using thresholds ranging between 0.2 and 0.8 were compared with the actual infarct volume to determine the most accurate thresholds.
RESULTS
Among the 47 subjects, the following baseline computed tomography perfusion thresholds most accurately predicted the actual 27-hour infarct volume: rCBV=0.32, median absolute error (MAE)=9 mL; rCBV=0.34, MAE=9 mL; rCBF=0.30, MAE=8.8 mL; rCBF=0.32, MAE=7 mL; and rCBF=0.34, MAE=7.3.
CONCLUSIONS
Brain regions with rCBF 0.30 to 0.34 or rCBV 0.32 to 0.34 thresholds provided the most accurate prediction of infarct volume in patients who achieved complete reperfusion with MAEs of ≤9 mL.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
背景与目的
计算机断层扫描灌注成像可估算缺血核心区的大小，其可用于选择血管内治疗的患者。用于识别缺血核心区的相对脑血容量（rCBV）和相对脑血流量（rCBF）阈值会影响预测的准确性。我们旨在利用SWIFT PRIME试验（以血栓切除术作为主要血管内治疗手段的Solitaire）数据中的RAPID自动分析软件，分析各种rCBV和rCBF阈值预测27小时梗死体积的准确性。
方法
纳入SWIFT PRIME研究中基于27小时时残差函数达到峰值>6秒灌注图实现完全再灌注的患者。仅接受静脉组织型纤溶酶原激活剂治疗组和血管内治疗组的患者均纳入分析。最终梗死体积通过症状发作后27小时获得的磁共振成像（液体衰减反转恢复图像）或计算机断层扫描确定。将使用0.2至0.8范围内阈值的rCBV和rCBF图上预测的缺血核心区体积与实际梗死体积进行比较，以确定最准确的阈值。
结果
在47名受试者中，以下基线计算机断层扫描灌注阈值最准确地预测了实际27小时梗死体积：rCBV = 0.32，中位绝对误差（MAE）= 9 mL；rCBV = 0.34，MAE = 9 mL；rCBF = 0.30，MAE = 8.8 mL；rCBF = 0.32，MAE = 7 mL；rCBF = 0.34，MAE = 7.3。
结论
对于实现完全再灌注且MAE≤9 mL的患者，rCBF为0.30至0.34或rCBV为0.32至0.34阈值的脑区对梗死体积的预测最为准确。
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