通透性成像作为动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测指标。
Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
机构信息
1 USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
4 Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
出版信息
J Cereb Blood Flow Metab. 2018 Jun;38(6):973-979. doi: 10.1177/0271678X18768670. Epub 2018 Apr 3.
Abstract
Blood-brain barrier (BBB) dysfunction has been implicated in ischemic risk following aneurysmal subarachnoid hemorrhage (aSAH), but never directly imaged. We prospectively examined whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). Global MR-derived BBB permeability ( K) was significantly higher in aSAH patients who subsequently developed DCI (five patients; 2.28 ± 0.09 × 10 min) compared to those who experienced radiographic vasospasm only (three patients; 1.85 ± 0.12 × 10 min; p < 0.05), or no vasospasm/ischemia (eight patients; 1.74 ± 0.07 × 10 min; p < 0.01). K > 2 × 10 min predicted development of DCI (AUC = 0.98, 95% CI: 0.93-1). Global BBB dysfunction following aSAH is detectable with DCE-MR and predictive of ischemic risk.
摘要
血脑屏障（BBB）功能障碍与动脉瘤性蛛网膜下腔出血（aSAH）后的缺血风险有关，但从未直接成像过。我们前瞻性地研究了出血后第 4 天的动态对比增强磁共振（DCE-MR）BBB 通透性成像是否可以预测迟发性脑缺血（DCI）的发生。与仅发生影像学血管痉挛的患者（3 例，1.85±0.12×10 min；p<0.05）或无血管痉挛/缺血的患者（8 例，1.74±0.07×10 min；p<0.01）相比，随后发生 DCI 的 aSAH 患者的全局 MR 衍生 BBB 通透性（K）显著更高（5 例，2.28±0.09×10 min）。K>2×10 min 可预测 DCI 的发生（AUC=0.98，95%CI：0.93-1）。DCE-MR 可检测到 aSAH 后全脑 BBB 功能障碍，并可预测缺血风险。
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