Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China.
Center for Cognition and Brain Disorders, Institutes of Neurological Science, Hangzhou Normal University, Hangzhou, China.
Eur Radiol. 2017 Dec;27(12):5280-5289. doi: 10.1007/s00330-017-4868-y. Epub 2017 May 24.
We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion.
We retrospectively examined data in consecutive anterior circulation AIS patients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10 mm/s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6 s lesion volume of ≥70% between baseline and 24 h.
82 patients were included. Binary logistic regression revealed that both CST-Tmax and CST-ADC volume at baseline were significantly associated with poor outcome (p < 0.05). The 24-h CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p = 0.04).
The use of CST-Tmax in combination with CST-ADC provides prognostic information in patients considered for reperfusion therapies.
• Examine the impact of corticospinal tract involvement in acute ischaemic stroke patients. • Spatially registered Tmax images can identify corticospinal tract hypoperfusion injury. • Corticospinal tract salvage through reperfusion is associated with improved outcome.
本研究旨在探讨皮质脊髓束（CST）受累对急性缺血性脑卒中（AIS）患者功能结局的影响，以及与再灌注的相互作用。
我们回顾性分析了连续接受溶栓治疗的前循环 AIS 患者的数据。MR 灌注（组织残留功能最大值的时间，Tmax）和表观扩散系数（ADC）图像被转化为标准空间，通过 Tmax＞6 s（CST-Tmax）和 ADC＜620×10mm/s（CST-ADC）病变计算 CST 受累体积。良好结局定义为 3 个月时改良 Rankin 量表评分≤2。再灌注定义为基线至 24 小时 Tmax＞6 s 病变体积减少≥70%。
共纳入 82 例患者。二元逻辑回归显示，基线时 CST-Tmax 和 CST-ADC 体积均与不良结局显著相关（p＜0.05）。在有再灌注的患者中，24 小时 CST-ADC 体积与基线 CST-ADC 体积相关（r＝0.79，p＜0.001），在无再灌注的患者中，与基线 CST-Tmax 体积相关（r＝0.67，p＜0.001）。在 CST-Tmax 体积＞0 mL 且 CST-ADC 体积＜3 mL 的患者中，有再灌注的患者良好结局的比例高于无再灌注的患者（70.4% vs 38.1%，p＝0.04）。
在考虑进行再灌注治疗的患者中，使用 CST-Tmax 结合 CST-ADC 可提供预后信息。
评估皮质脊髓束受累对急性缺血性脑卒中患者的影响。
空间配准的 Tmax 图像可识别皮质脊髓束低灌注损伤。
通过再灌注挽救皮质脊髓束与改善结局相关。
