FLAIR 血管高信号是否代表再灌注治疗前的良好侧支循环？
Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy?
机构信息
From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.).
Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France.
出版信息
AJNR Am J Neuroradiol. 2018 Jan;39(1):77-83. doi: 10.3174/ajnr.A5431. Epub 2017 Oct 26.
BACKGROUND AND PURPOSE
In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio.
MATERIALS AND METHODS
We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio.
RESULTS
Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19-0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3-5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals ( = .002).
CONCLUSIONS
In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.
背景与目的
在急性缺血性脑卒中患者中，FLAIR 血管高信号代表良好或不良的侧支循环一直存在争议。我们假设广泛的 FLAIR 血管高信号与良好的侧支循环相对应，这可以通过低灌注强度比间接评估。
材料与方法
我们纳入了 244 例符合 MCA 卒中再灌注治疗条件且有预处理 FLAIR 和 PWI 磁共振成像的连续患者。FLAIR 血管高信号评分基于 ASPECTS，范围从 0（无 FLAIR 血管高信号）到 7（FLAIR 血管高信号与所有 ASPECTS 皮质区域相邻）。低灌注强度比定义为时间至最大＞10 秒病变体积与时间至最大＞6 秒病变体积的比值。采用中位数低灌注强度比将侧支循环分为良好（低低灌注强度比）和不良（高高灌注强度比）。然后，我们研究了 FLAIR 血管高信号程度与低灌注强度比之间的关系。
结果
所有患者均存在低灌注，低灌注强度比的中位数为 0.35（四分位间距，0.19-0.48）。FLAIR 血管高信号评分的中位数为 4（四分位间距，3-5）。在侧支循环良好（低灌注强度比≤0.35）的患者中，FLAIR 血管高信号更广泛，而在侧支循环不良（低灌注强度比＞0.35）的患者中，FLAIR 血管高信号更广泛（ =.016）。FLAIR 血管高信号评分与侧支循环良好独立相关（ =.002）。
结论
在适合再灌注治疗的患者中，FLAIR 血管高信号程度与侧支循环良好相关，这可以通过预处理低灌注强度比来评估。FLAIR 血管高信号的 ASPECTS 评估可以快速识别更可能从再灌注治疗中获益的患者。
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