Pereira Daniela, Fragata Isabel, Amorim José, Reis João
1 Centro Hospitalar e Universitário de Coimbra, Portugal.
2 Centro Hospitalar de Lisboa Central, Portugal.
Neuroradiol J. 2017 Dec;30(6):586-592. doi: 10.1177/1971400917706197. Epub 2017 Jul 12.
Background Acute ischemic stroke due to basilar artery occlusion (BAO) is associated with a dismal prognosis and, even though endovascular treatment (EVT) contributed to an improvement in clinical outcomes, patient selection is difficult and frequently results in futile recanalization. We investigated the prognostic value of baseline ADC quantification in patients with BAO undergoing EVT. Methods We retrospectively evaluated MRI at admission in 11 patients with BAO undergoing EVT. Ischemic lesions were defined on baseline DWI and minimum ADC (minADC), ADC ratio and total area were quantified. Final infarction area was determined on follow-up T2WI/CT. We assessed the correlation between imaging parameters, recanalization grade and clinical scores (NIHSS at admission, NIHSS and mRS at discharge and mRS at three months) using Spearman rank correlation coefficient and correcting for multiple comparisons with the false discovery rate (FDR). Results Lower values of minADC at admission MRI are strongly correlated with higher scores in NIHSS (r = -0.845, p = 0.001) and mRS at discharge (r = -0.743, p = 0.009). We also found a negative correlation between minADC and NIHSS at admission (r = -0.67, p = 0.02), mRS at three months and difference between pre- and post-treatment ischemic area (r = -0.664, p = 0.026) that lost significance with FDR correction. Ischemic area and TICI grade were not significantly associated with clinical results. Conclusions ADC quantification of ischemic lesions at baseline MRI seems to predict clinical outcome in patients with BAO undergoing EVT, more importantly than ischemic area or TICI grade.
基底动脉闭塞（BAO）所致急性缺血性卒中预后不佳，尽管血管内治疗（EVT）有助于改善临床结局，但患者选择困难，且常导致无效再通。我们研究了接受EVT的BAO患者基线表观扩散系数（ADC）定量的预后价值。方法：我们回顾性评估了11例接受EVT的BAO患者入院时的磁共振成像（MRI）。根据基线扩散加权成像（DWI）定义缺血性病变，并对最小ADC（minADC）、ADC比值和总面积进行定量。在随访的T2加权成像（T2WI）/计算机断层扫描（CT）上确定最终梗死面积。我们使用Spearman等级相关系数评估成像参数、再通等级和临床评分（入院时美国国立卫生研究院卒中量表[NIHSS]、出院时NIHSS和改良Rankin量表[mRS]以及3个月时mRS）之间的相关性，并采用错误发现率（FDR）校正进行多重比较。结果：入院时MRI的minADC值较低与NIHSS评分较高（r = -0.845，p = 0.001）和出院时mRS评分较高（r = -0.743，p = 0.009）密切相关。我们还发现minADC与入院时NIHSS（r = -0.67，p = 0.02）、3个月时mRS以及治疗前后缺血面积之差（r = -0.664，p = 0.026）之间存在负相关，经FDR校正后这种相关性失去意义。缺血面积和脑梗死溶栓分级（TICI）与临床结果无显著相关性。结论：基线MRI上缺血性病变的ADC定量似乎可以预测接受EVT的BAO患者的临床结局，比缺血面积或TICI分级更重要。
