From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.).
Stroke. 2018 Apr;49(4):931-937. doi: 10.1161/STROKEAHA.118.020698. Epub 2018 Mar 9.
Ipsilateral thalamic diaschisis (ITD) describes the reduction of thalamic function, metabolism, and perfusion resulting from a distant lesion of the ipsilateral hemisphere. Our aim was to evaluate the perfusion characteristics and clinical impact of ITD in acute middle cerebral artery stroke, which does not directly affect the thalamus.
One hundred twenty-four patients with middle cerebral artery infarction were selected from a prospectively acquired cohort of 1644 patients who underwent multiparametric computed tomography (CT), including CT perfusion for suspected stroke. Two blinded readers evaluated the occurrence of ITD, defined as ipsilateral thalamic hypoperfusion present on ≥2 CT perfusion maps. Perfusion alterations were defined according to the Alberta Stroke Program Early CT Score regions. Final infarction volume and subacute complications were assessed on follow-up imaging. Clinical outcome was quantified using the modified Rankin Scale. Multivariable linear and ordinal logistic regression analysis were applied to identify independent associations.
ITD was present in 25/124 subjects (20.2%, ITD+). In ITD+ subjects, perfusion of the caudate nucleus, internal capsule, and lentiform nucleus was more frequently affected than in ITD- patients (each with <0.001). In the ITD+ group, larger cerebral blood flow (=0.002) and cerebral blood volume (<0.001) deficit volumes, as well as smaller cerebral blood flow-cerebral blood volume mismatch (=0.021) were observed. There was no independent association of ITD with final infarction volume or clinical outcome at discharge in treatment subgroups (each with >0.05). ITD had no influence on the development of subacute stroke complications.
ITD in the form of thalamic hypoperfusion is a frequent CT perfusion finding in the acute phase in middle cerebral artery stroke patients with marked involvement of subcortical areas. ITD does not result in thalamic infarction and had no independent impact on patient outcome. Notably, ITD was misclassified as part of the ischemic core by automated software, which might affect patient selection in CT perfusion-based trials.
同侧丘脑旁脱抑制（ITD）描述了由于对侧大脑半球的远处病变导致的丘脑功能、代谢和灌注减少。我们的目的是评估急性大脑中动脉卒中（MCA）中 ITD 的灌注特征和临床影响，这种卒中不会直接影响丘脑。
从 1644 例接受多参数 CT（包括 CT 灌注）检查的疑似卒中患者前瞻性队列中选择 124 例大脑中动脉梗死患者。两名盲法读者评估 ITD 的发生情况，定义为在≥2 张 CT 灌注图上存在同侧丘脑灌注不足。根据阿尔伯塔卒中计划早期 CT 评分区域定义灌注改变。在随访影像上评估最终梗死体积和亚急性并发症。使用改良 Rankin 量表评估临床结局。应用多元线性和有序逻辑回归分析识别独立关联。
25/124 例（20.2%，ITD+）患者存在 ITD。在 ITD+患者中，尾状核、内囊和豆状核的灌注比 ITD-患者更常受到影响（均<0.001）。在 ITD+组中，观察到更大的脑血流量（=0.002）和脑血容量（<0.001）缺损体积，以及更小的脑血流量-脑血容量不匹配（=0.021）。在治疗亚组中，ITD 与最终梗死体积或出院时临床结局无独立关联（均>0.05）。ITD 对亚急性卒中并发症的发展无影响。
在大脑中动脉卒中患者的急性期，以丘脑灌注不足为表现的 ITD 是一种常见的 CT 灌注发现，其明显累及皮质下区域。ITD 不会导致丘脑梗死，也不会对患者预后产生独立影响。值得注意的是，ITD 被自动软件错误分类为缺血核心的一部分，这可能会影响 CT 灌注试验中的患者选择。
