From the Department of Radiology (J.J.H., M.W., B.W.M., G.Z., M.P.M., G.Z., H.M.D.), Department of Neurosurgery (R.L.D., G.K.S.), and Department of Neurology (M.G.L., G.W.A.), Stanford Healthcare, CA; and Department of Radiology, University of Basle, Diagnostic and Interventional Neuroradiology, Petersgraben, Switzerland (C.F.).
Stroke. 2018 Mar;49(3):741-745. doi: 10.1161/STROKEAHA.117.020395. Epub 2018 Feb 9.
Proximal artery vasospasm and delayed cerebral ischemia (DCI) after cerebral aneurysm rupture result in reduced cerebral perfusion and microperfusion and significant morbidity and mortality. Intravoxel incoherent motion (IVIM) magnetic resonance imaging extracts microvascular perfusion information from a multi-b value diffusion-weighted sequence. We determined whether decreased IVIM perfusion may identify patients with proximal artery vasospasm and DCI.
We performed a pilot retrospective cohort study of patients with ruptured cerebral aneurysms. Consecutive patients who underwent a brain magnetic resonance imaging with IVIM after ruptured aneurysm treatment were included. Patient demographic, treatment, imaging, and outcome data were determined by electronic medical record review. Primary outcome was DCI development with proximal artery vasospasm that required endovascular treatment. Secondary outcomes included mortality and clinical outcomes at 6 months.
Sixteen patients (11 females, 69%; =0.9) were included. There were no differences in age, neurological status, or comorbidities between patients who subsequently underwent endovascular treatment of DCI (10 patients; DCI+ group) and those who did not (6 patients; DCI- group). Compared with DCI- patients, DCI+ patients had decreased IVIM perfusion fraction (0.09±0.03 versus 0.13±0.01; =0.03), reduced diffusion coefficient (0.82±0.05 versus 0.92±0.07×10 mm/s; =0.003), and reduced blood flow-related parameter * (1.18±0.40 versus 1.83±0.40×10 mm/s; =0.009). IVIM pseudodiffusion coefficient * did not differ between DCI- (0.011±0.002) and DCI+ (0.013±0.005 mm/s; =0.4) patients. No differences in mortality or clinical outcome were identified.
Decreased IVIM perfusion fraction and blood flow-related parameter * correlate with DCI and proximal artery vasospasm development after cerebral aneurysm rupture.
脑动脉瘤破裂后，近端动脉血管痉挛和迟发性脑缺血（DCI）会导致脑灌注和微循环减少，从而显著增加发病率和死亡率。体素内不相干运动（IVIM）磁共振成像可从多 b 值扩散加权序列中提取微血管灌注信息。我们旨在确定 IVIM 灌注降低是否可识别伴有近端动脉血管痉挛和 DCI 的患者。
我们对破裂脑动脉瘤患者进行了一项试点回顾性队列研究。纳入破裂动脉瘤治疗后行脑磁共振成像 IVIM 的连续患者。通过电子病历回顾确定患者的人口统计学、治疗、影像学和结局数据。主要结局为伴有近端动脉血管痉挛且需要血管内治疗的 DCI 发展。次要结局包括 6 个月时的死亡率和临床结局。
共纳入 16 例患者（11 例女性，69%；=0.9）。DCI 行血管内治疗的患者（10 例；DCI+组）与未行血管内治疗的患者（6 例；DCI-组）在年龄、神经状态或合并症方面无差异。与 DCI-患者相比，DCI+患者的 IVIM 灌注分数较低（0.09±0.03 比 0.13±0.01；=0.03），扩散系数较低（0.82±0.05 比 0.92±0.07×10 mm/s；=0.003），血流相关参数 * 降低（1.18±0.40 比 1.83±0.40×10 mm/s；=0.009）。DCI-（0.011±0.002）和 DCI+（0.013±0.005 mm/s；=0.4）患者的 IVIM 假性扩散系数 * 无差异。两组间死亡率或临床结局无差异。
IVIM 灌注分数降低和血流相关参数 * 与脑动脉瘤破裂后 DCI 和近端动脉血管痉挛的发生相关。
