Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
PLoS One. 2018 Apr 4;13(4):e0195554. doi: 10.1371/journal.pone.0195554. eCollection 2018.
T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS).
Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed. Acute recanalization was defined as an arterial occlusive lesion score of 2-3. A modified Alberta Stroke Program Early CT Score (mASPECTS) was used to evaluate ischemic areas revealed by SWAN and DWI. SWAN- and DWI-based mASPECTSs were calculated, and correlations between DWI-SWAN mismatches with final infarct lesions or clinical outcomes were evaluated.
Among the 35 patients included in this study, we confirmed cardioembolic stroke in 26, atherothrombotic stroke in 4, and unknown stroke etiology in 5. Overall, recanalization was achieved in 23 patients, who showed a higher follow-up DWI-based mASPECTS and lower modified Rankin Scale (mRS) score at 90 days than patients without recanalization. Initial SWAN- and follow-up DWI-based mASPECTSs were significantly higher for atherothrombotic stroke than for cardioembolic stroke. Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth. Patients with recanalization showed no such correlation. In the assessment of clinical outcome, follow-up DWI-based mASPECTS and patient's age were significantly correlated with mRS at 90 days after stroke. A multivariate logistic regression analysis revealed that the follow-up DWI-based mASPECTS was independently associated with a favorable outcome 90 days after stroke.
For patients with AIS, DWI-SWAN mismatch might show penumbra-like lesions that would predict infarct growth without acute recanalization. Assessment of ischemic lesions from the venous side appears to be useful for considering the etiology and revascularization therapy.
T2*-加权磁共振血管造影（SWAN）通过检测髓质或皮质静脉中的低信号区域来检测血流动力学不足。因此，我们研究了 SWAN 是否可以帮助预测急性缺血性脑卒中（AIS）患者的缺血半暗带样病变。
对发病 6 小时内的大血管闭塞性 AIS 患者的连续磁共振成像（MRI）记录（包括 SWAN、弥散加权成像（DWI）和磁共振血管造影（MRA））进行了分析。急性再通定义为动脉闭塞性病变评分 2-3 分。采用改良的 Alberta 卒中计划早期 CT 评分（mASPECTS）评估 SWAN 和 DWI 显示的缺血区。计算了基于 SWAN 和 DWI 的 mASPECTS，并评估了 DWI-SWAN 不匹配与最终梗死病变或临床结局的相关性。
在本研究纳入的 35 例患者中，我们证实了 26 例心源性栓塞性卒中、4 例动脉粥样硬化血栓性卒中和 5 例病因不明的卒中。总的来说，23 例患者实现了再通，这些患者在 90 天的随访中 DWI 基于的 mASPECTS 更高，改良 Rankin 量表（mRS）评分更低。与心源性栓塞性卒中相比，动脉粥样硬化血栓性卒中患者的初始 SWAN 和随访 DWI 基于的 mASPECTS 更高。在 12 例未再通的患者中，DWI-SWAN 不匹配与梗死进展显著相关。再通患者则无相关性。在临床结局评估中，随访 DWI 基于的 mASPECTS 和患者年龄与卒中后 90 天的 mRS 显著相关。多变量逻辑回归分析显示，随访 DWI 基于的 mASPECTS 与卒中后 90 天的良好结局独立相关。
对于 AIS 患者，DWI-SWAN 不匹配可能显示出半暗带样病变，这些病变可能预测未发生急性再通的梗死进展。从静脉侧评估缺血性病变似乎有助于考虑病因和血管再通治疗。
