急性缺血性脑卒中患者缺血性病变体积与功能预后的相关性：24小时与1周影像学对比
Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke: 24-Hour Versus 1-Week Imaging.
作者信息
Bucker Amber, Boers Anna M, Bot Joseph C J, Berkhemer Olvert A, Lingsma Hester F, Yoo Albert J, van Zwam Wim H, van Oostenbrugge Robert J, van der Lugt Aad, Dippel Diederik W J, Roos Yvo B W E M, Majoie Charles B L M, Marquering Henk A
机构信息
From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
出版信息
Stroke. 2017 May;48(5):1233-1240. doi: 10.1161/STROKEAHA.116.015156. Epub 2017 Mar 28.
BACKGROUND AND PURPOSE
Ischemic lesion volume (ILV) on noncontrast computed tomography at 1 week can be used as a secondary outcome measure in patients with acute ischemic stroke. Twenty-four-hour ILV on noncontrast computed tomography has greater availability and potentially allows earlier estimation of functional outcome. We aimed to assess lesion growth 24 hours after stroke onset and compare the associations of 24-hour and 1-week ILV with functional outcome.
METHODS
We included 228 patients from MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), who received noncontrast computed tomography at 24-hour and 1-week follow-up on which ILV was measured. Relative and absolute lesion growth was determined. Logistic regression models were constructed either including the 24-hour or including the 1-week ILV. Ordinal and dichotomous (0-2 and 3-6) modified Rankin scale scores were, respectively, used as primary and secondary outcome measures.
RESULTS
Median ILV was 42 mL (interquartile range, 21-95 mL) and 64 mL (interquartile range: 30-120 mL) at 24 hours and 1 week, respectively. Relative lesion growth exceeding 30% occurred in 121 patients (53%) and absolute lesion growth exceeding 20 mL occurred in 83 patients (36%). Both the 24-hour and 1-week ILVs were similarly significantly associated with functional outcome (both <0.001). In the logistic analyses, the areas under the curve of the receiver-operator characteristic curves were similar: 0.85 (95% confidence interval, 0.80-0.90) and 0.87 (95% confidence interval, 0.82-0.91) for including the 24-hour and 1-week ILV, respectively.
CONCLUSIONS
Growth of ILV is common 24-hour poststroke onset. Nevertheless, the 24-hour ILV proved to be a valuable secondary outcome measure as it is equally strongly associated with functional outcome as the 1-week ILV.
CLINICAL TRIAL REGISTRATION
URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
背景与目的
急性缺血性脑卒中患者在发病1周时非增强计算机断层扫描的缺血性病变体积（ILV）可作为次要结局指标。发病24小时时非增强计算机断层扫描的ILV具有更高的可获取性，并且可能有助于更早地预测功能结局。我们旨在评估卒中发病24小时后的病变生长情况，并比较发病24小时和1周时的ILV与功能结局之间的关联。
方法
我们纳入了来自MR CLEAN试验（荷兰急性缺血性脑卒中血管内治疗多中心随机临床试验）的228例患者，这些患者在发病24小时和1周时接受了非增强计算机断层扫描，并测量了ILV。确定相对和绝对病变生长情况。构建了包含发病24小时或1周时ILV的逻辑回归模型。分别将有序和二分法（0-2分和3-6分）改良Rankin量表评分用作主要和次要结局指标。
结果
发病24小时和1周时，ILV的中位数分别为42 mL（四分位间距，21-95 mL）和64 mL（四分位间距：30-120 mL）。121例患者（53%）的相对病变生长超过30%，83例患者（36%）的绝对病变生长超过20 mL。发病24小时和1周时的ILV与功能结局均显著相关（均P<0.001）。在逻辑分析中，受试者工作特征曲线下面积相似：包含发病24小时和1周时ILV的曲线下面积分别为0.85（95%置信区间，0.80-0.90）和0.87（95%置信区间，0.82-0.91）。
结论
发病24小时后ILV生长很常见。然而，发病24小时时的ILV被证明是一个有价值的次要结局指标，因为它与功能结局的关联强度与发病1周时的ILV相同。
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