Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Eur Radiol. 2018 Feb;28(2):642-649. doi: 10.1007/s00330-017-5025-3. Epub 2017 Aug 30.
We aimed to detect early changes of the blood-brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes.
Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability-surface area product (rPS) was calculated within the hypoperfused region (rPS), non-hypoperfused region of ischaemic hemisphere (rPS) and their contralateral mirror regions (rPS and rPS). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome.
Fifty-six patients were included in the analysis, median age was 76 (IQR 62-81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPS, rPS and rPS all decreased significantly. The decreases in rPS and rPS were larger in the reperfusion group than non-reperfusion group. The rPS at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018-1.256; P = 0.022).
Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome.
• Early disruption of blood-brain barrier (BBB) in stroke is reversible after treatment. • The reversibility of BBB permeability is associated with reperfusion. • Unfavourable outcome is associated with BBB permeability at 24 h after treatment. • Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.
本研究旨在检测伴或不伴有再灌注的急性缺血性卒中（AIS）患者血脑屏障通透性（BBBP）的早期变化，并探讨 BBBP 是否可以预测临床转归。
本研究连续纳入了发病 24 小时内行 CT 灌注成像（CTP）检查的 AIS 患者。在低灌注区（rPS）、缺血半球的非低灌注区（rPS）及其对侧镜像区（rPS 和 rPS）计算相对渗透率表面积乘积（rPS）。采用重复测量方差分析（ANOVA）分析 rPS 的变化。采用 logistic 回归分析识别不良预后的独立预测因素。
本研究共纳入 56 例患者，中位年龄为 76（62-81）岁，28 例（50%）为女性。从基线到治疗后 24 小时，rPS、rPS 和 rPS 均显著降低。与无再灌注组相比，再灌注组 rPS 和 rPS 的降低更为明显。随访时的 rPS 是不良预后的预测因素（OR 1.131；95%CI 1.018-1.256；P=0.022）。
AIS 患者早期 BBB 破坏是可逆的，尤其是在再灌注程度较高时。治疗后 24 小时 BBBP 升高而不是治疗前 BBBP 升高与不良预后相关。
• 卒中后早期血脑屏障（BBB）破坏是可逆转的。• BBB 通透性的可逆性与再灌注相关。• 治疗后 24 小时 BBBP 与不良预后相关。• 急性卒中时对侧非缺血半球并非“正常”。
