Shinoda N, Hori S, Mikami K, Bando T, Shimo D, Kuroyama T, Kuramoto Y, Matsumoto M, Hirai O, Ueno Y
Department of Neurosurgery, Shinko Hospital, 1-4-47 Wakinohama-cho, Chuo-ku, Kobe, 651-0072 Hyogo, Japan.
Department of Neurosurgery, Shinko Hospital, 1-4-47 Wakinohama-cho, Chuo-ku, Kobe, 651-0072 Hyogo, Japan.
J Neuroradiol. 2017 Oct;44(6):361-366. doi: 10.1016/j.neurad.2017.07.003. Epub 2017 Sep 1.
The relative apparent diffusion coefficient (ADC) ratio can be used to evaluate the extent of ischemia. We investigated the risk factors for, and correlation between, relative ADC ratio and hemorrhagic transformation (HT) after thrombolysis.
This single-center, retrospective study involved 105 patients with acute occlusion of the anterior circulation. Relative ADC ratio was calculated as the ratio of ADC pixel values, within the affected territory to ADC pixel values in the contralateral normal region. HT was determined by computed tomography and T2* weighted magnetic resonance imaging after endovascular revascularization.
Data for 80 of the 105 patients were analyzed. Comparing the number of patients between the HT group (n=25) and the non-HT group (n=55), a significant difference was noted in tissue plasminogen activator (tPA) use (P=0.028), time from onset to reperfusion ≥380min (P<0.001), fluid-attenuated inversion recovery (FLAIR) hyperintensity (P=0.009), and relative ADC ratio<0.650 (P<0.001). Multivariable logistic regression analysis identified relative ADC ratio<0.650 as the only independent predictor of HT (odds ratio 7.79; 95% confidence interval 2.22-27.3; P=0.001). Twenty-nine patients (including 20 in the HT group) had a relative ADC ratio<0.650. Multivariable logistic regression analysis identified use of tPA as the only independent predictor of HT (odds ratio 13.8; 95% confidence interval 1.35-125.5; P=0.010).
Relative ADC ratio<0.650 with use of tPA may be important for predicting HT.
相对表观扩散系数（ADC）比值可用于评估缺血程度。我们研究了溶栓后相对ADC比值与出血性转化（HT）的危险因素及相关性。
这项单中心回顾性研究纳入了105例急性前循环闭塞患者。相对ADC比值计算为患侧区域内ADC像素值与对侧正常区域ADC像素值之比。HT通过血管内血运重建术后的计算机断层扫描和T2*加权磁共振成像确定。
分析了105例患者中的80例数据。比较HT组（n = 25）和非HT组（n = 55）的患者数量，发现组织纤溶酶原激活剂（tPA）的使用（P = 0.028）、从发病到再灌注时间≥380分钟（P < 0.001）、液体衰减反转恢复（FLAIR）高信号（P = 0.009）以及相对ADC比值<0.650（P < 0.001）存在显著差异。多变量逻辑回归分析确定相对ADC比值<0.650是HT的唯一独立预测因素（比值比7.79；95%置信区间2.22 - 27.3；P = 0.001）。29例患者（包括HT组中的20例）相对ADC比值<0.650。多变量逻辑回归分析确定tPA的使用是HT的唯一独立预测因素（比值比13.8；95%置信区间1.35 - 125.5；P = 0.010）。
使用tPA时相对ADC比值<0.650可能对预测HT很重要。
