Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Medical Center, Stanford, California, USA.
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
J Neurointerv Surg. 2018 Dec;10(12):1132-1136. doi: 10.1136/neurintsurg-2018-013784. Epub 2018 Mar 19.
Acute ischemic stroke (AIS) patients who benefit from endovascular treatment have a large vessel occlusion (LVO), small core infarction, and salvageable brain. We determined if diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) alone can correctly identify and localize anterior circulation LVO and accurately triage patients to endovascular thrombectomy (ET).
This retrospective cohort study included patients undergoing MRI for the evaluation of AIS symptoms. DWI and PWI images alone were anonymized and scored for cerebral infarction, LVO presence and LVO location, DWI-PWI mismatch, and ET candidacy. Readers were blinded to clinical data. The primary outcome measure was accurate ET triage. Secondary outcomes were detection of LVO and LVO location.
Two hundred and nineteen patients were included. Seventy-three patients (33%) underwent endovascular AIS treatment. Readers correctly and concordantly triaged 70 of 73 patients (96%) to ET (κ=0.938; P=0.855) and correctly excluded 143 of 146 patients (98%; P=0.942). DWI and PWI alone had a 95.9% sensitivity and a 98.4% specificity for accurate endovascular triage. LVO were accurately localized to the ICA/M1 segment in 65 of 68 patients (96%; κ=0.922; P=0.817) and the M2 segment in 18 of 20 patients (90%; κ=0.830; P=0.529).
AIS patients with anterior circulation LVO are accurately identified using DWI and PWI alone, and LVO location may be correctly inferred from PWI. MRA omission may be considered to expedite AIS triage in hyperacute scenarios or may confidently supplant non-diagnostic or artifact-limited MRA.
受益于血管内治疗的急性缺血性脑卒中（AIS）患者存在大血管闭塞（LVO）、小核心梗死和可挽救的脑组织。我们旨在确定弥散加权成像（DWI）和灌注加权成像（PWI）是否可以单独正确识别和定位前循环 LVO，并准确对患者进行血管内血栓切除术（ET）的分诊。
本回顾性队列研究纳入了因 AIS 症状而行 MRI 检查的患者。DWI 和 PWI 图像被匿名化并进行评分，以评估脑梗死、LVO 存在和 LVO 部位、DWI-PWI 不匹配以及 ET 适应证。读者对临床数据不知情。主要结局指标是准确的 ET 分诊。次要结局是检测 LVO 和 LVO 部位。
共纳入 219 例患者。73 例（33%）患者接受了血管内 AIS 治疗。读者正确且一致地对 73 例患者中的 70 例（96%）进行了 ET 分诊（κ=0.938；P=0.855），对 146 例患者中的 143 例（98%）进行了排除（P=0.942）。DWI 和 PWI 单独用于准确的血管内分诊的敏感性为 95.9%，特异性为 98.4%。68 例患者中的 65 例（96%）LVO 准确定位在颈内动脉/大脑中动脉（ICA/M1）段，20 例患者中的 18 例（90%）LVO 定位在 M2 段（κ=0.922；P=0.817）。
单独使用 DWI 和 PWI 可以准确识别前循环 LVO，并且可以从 PWI 正确推断 LVO 部位。在超急性期或在非诊断性或因伪影限制的 MRA 情况下，可以考虑省略 MRA 以加快 AIS 的分诊，或者可以有信心地替代非诊断性或因伪影限制的 MRA。
