早期影像学预测急性缺血性脑卒中恶性小脑水肿的发生。
Early Imaging Prediction of Malignant Cerebellar Edema Development in Acute Ischemic Stroke.
机构信息
From the Institute for Clinical Radiology (M.P.F., K.M.T., F.G.M., B.O.S., B.E.-W., W.H.S., W.G.K.), Department of Neuroradiology (F.D.), and Department of Neurology (P.S.), Ludwig-Maximilians-University Hospital Munich, Germany; and Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Germany (A.E.O.).
出版信息
Stroke. 2017 Sep;48(9):2597-2600. doi: 10.1161/STROKEAHA.117.018237. Epub 2017 Jul 7.
BACKGROUND AND PURPOSE
Malignant cerebellar edema (MCE) is a life-threatening complication of acute ischemic stroke that requires timely diagnosis and management. Aim of this study was to identify imaging predictors in initial multiparametric computed tomography (CT), including whole-brain CT perfusion (WB-CTP).
METHODS
We consecutively selected all subjects with cerebellar ischemic WB-CTP deficits and follow-up-confirmed cerebellar infarction from an initial cohort of 2635 patients who had undergone multiparametric CT because of suspected stroke. Follow-up imaging was assessed for the presence of MCE, measured using an established 10-point scale, of which scores ≥4 are considered malignant. Posterior circulation-Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was determined to assess ischemic changes on noncontrast CT, CT angiography (CTA), and parametric WB-CTP maps (cerebellar blood flow [CBF]; cerebellar blood volume; mean transit time; time to drain). Fisher's exact tests, Mann-Whitney U tests, and receiver operating characteristics analyses were performed for statistical analyses.
RESULTS
Out of a total of 51 patients who matched the inclusion criteria, 42 patients (82.4%) were categorized as MCE- and 9 (17.6%) as MCE+. MCE+ patients had larger CBF, cerebellar blood volume, mean transit time, and time to drain deficit volumes (all with <0.001) and showed significantly lower median pc-ASPECTS assessed using WB-CTP (CBF, cerebellar blood volume, mean transit time, time to drain; all with <0.001) compared with MCE- patients, while median pc-ASPECTS on noncontrast CT and CTA was not significantly different (both >0.05). Receiver operating characteristics analyses yielded the largest area under the curve values for the prediction of MCE development for CBF (0.979) and cerebellar blood volume deficit volumes (0.956) and pc-ASPECTS on CBF (0.935), whereas pc-ASPECTS on noncontrast CT (0.648) and CTA (0.684) had less diagnostic value. The optimal cutoff value for CBF deficit volume was 22 mL, yielding 100% sensitivity and 90% specificity for MCE classification.
CONCLUSIONS
WB-CTP provides added diagnostic value for the early identification of patients at risk for MCE development in acute cerebellar stroke.
背景与目的
恶性小脑水肿（MCE）是急性缺血性脑卒中的一种危及生命的并发症，需要及时诊断和治疗。本研究旨在确定初始多参数 CT（包括全脑 CT 灌注[WB-CTP]）中的影像学预测因子。
方法
我们连续选择了来自 2635 例因疑似中风而接受多参数 CT 检查的初始队列中，具有小脑缺血性 WB-CTP 缺损和随访证实的小脑梗死的所有患者。使用既定的 10 分量表评估随访成像中是否存在 MCE，得分≥4 被认为是恶性的。后循环-急性卒中预后早期 CT 评分（pc-ASPECTS）用于评估非对比 CT、CT 血管造影（CTA）和参数性 WB-CTP 图（小脑血流[CBF]；小脑血容量；平均通过时间；引流时间）上的缺血性改变。进行 Fisher 确切检验、Mann-Whitney U 检验和受试者工作特征分析进行统计学分析。
结果
在总共 51 名符合纳入标准的患者中，42 名（82.4%）被归类为 MCE+，9 名（17.6%）为 MCE-。MCE+患者的 CBF、小脑血容量、平均通过时间和引流时间的 deficit 体积均较大（均<0.001），并且使用 WB-CTP 评估的 pc-ASPECTS 中位数明显较低（CBF、小脑血容量、平均通过时间、引流时间；均<0.001），而非对比 CT 和 CTA 上的 pc-ASPECTS 中位数没有明显差异（均>0.05）。受试者工作特征分析显示，CBF（0.979）和小脑血容量 deficit 体积（0.956）以及 CBF 上的 pc-ASPECTS（0.935）对 MCE 发展的预测具有最大的曲线下面积值，而非对比 CT（0.648）和 CTA（0.684）的诊断价值较低。CBF 缺损体积的最佳截断值为 22mL，对 MCE 分类的灵敏度为 100%，特异性为 90%。
结论
WB-CTP 为急性小脑卒中患者 MCE 发展风险的早期识别提供了额外的诊断价值。
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