Payabvash Seyedmehdi, Benson John C, Tyan Andrew E, Taleb Shayandokht, McKinney Alexander M
Department of Radiology, University of Minnesota, Minneapolis, Minneapolis; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
Department of Radiology, University of Minnesota, Minneapolis, Minneapolis.
J Stroke Cerebrovasc Dis. 2018 Apr;27(4):936-944. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.034. Epub 2017 Nov 29.
The information on topographic distribution of acute ischemic infarct can contribute to prediction of functional outcome. We aimed to develop a multivariate model for stroke prognostication, combining admission clinical and imaging variables, including the infarct topology.
Acute ischemic stroke patients without baseline functional disability who had magnetic resonance imaging within 24 hours of onset or last-seen-well were included. The admission stroke severity was determined using the National Institutes of Health Stroke Scale (NIHSS) score. The relation between infarct location and outcome was assessed using both voxel-based and visual atlas-based analyses. The disability/death was defined by a modified Rankin Scale score greater than 2 at 3-month follow-up.
Among 198 patients included in this study, higher admission NIHSS score (P < .001), larger infarct volume (P < .001), and major arterial occlusions (P < .001) were associated with disability/death in univariate analyses. On voxel-based analysis, infarcts in the middle centrum semiovale, insula, and midbrain/pons were associated with higher rates of disability/death. In multivariate analysis, admission NIHSS score (P < .001), infarction of insula (P = .005), and midbrain/pons (P = .006) were independent predictors of disability/death. In receiver operating characteristics analysis, a simple 0-to-3 scoring system using these 3 variables had an area under the curve of .812 for prediction of disability/death (P < .001).
Admission symptom severity, infarction of insula, and midbrain/pons were independent predictors of clinical outcome in acute ischemic stroke patients. The methodology of this hypothesis-generating study can help conceive quantitative population-based probabilistic models for prognostication or treatment triage in stroke patients, combining admission clinical and imaging findings-including infarct topography.
急性缺血性梗死的地形分布信息有助于预测功能预后。我们旨在开发一种多变量模型用于卒中预后评估，该模型结合入院时的临床和影像学变量，包括梗死灶拓扑结构。
纳入发病24小时内或最后一次情况良好时进行磁共振成像检查、且无基线功能残疾的急性缺血性卒中患者。使用美国国立卫生研究院卒中量表（NIHSS）评分确定入院时的卒中严重程度。采用基于体素和基于视觉图谱的分析方法评估梗死灶位置与预后的关系。残疾/死亡定义为随访3个月时改良Rankin量表评分大于2分。
本研究纳入的198例患者中，单因素分析显示，入院时较高的NIHSS评分（P <.001）、较大的梗死灶体积（P <.001）和主要动脉闭塞（P <.001）与残疾/死亡相关。基于体素的分析显示，半卵圆中心中部、岛叶和中脑/脑桥的梗死与较高的残疾/死亡率相关。多因素分析显示，入院时的NIHSS评分（P <.001）、岛叶梗死（P =.005）和中脑/脑桥梗死（P =.006）是残疾/死亡的独立预测因素。在受试者工作特征分析中，使用这3个变量的简单0至3评分系统预测残疾/死亡的曲线下面积为0.812（P <.001）。
入院时的症状严重程度、岛叶梗死和中脑/脑桥梗死是急性缺血性卒中患者临床预后的独立预测因素。这项探索性研究的方法有助于构建基于人群的定量概率模型，用于卒中患者的预后评估或治疗分诊，该模型结合了入院时的临床和影像学发现，包括梗死灶拓扑结构。
