Reimer Johanna, Montag Cornelia, Schuster Alexander, Moeller-Hartmann Walter, Sobesky Jan, Heiss Wolf-Dieter, Zaro-Weber Olivier
Max-Planck-Institute for Neurological Research, Cologne, Germany.
Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany.
Cerebrovasc Dis. 2018;46(1-2):16-23. doi: 10.1159/000490424. Epub 2018 Jul 13.
In acute stroke, the magnetic resonance (MR) imaging-based mismatch concept is used to select patients with tissue at risk of infarction for reperfusion therapies. There is however a controversy if non-deconvolved or deconvolved perfusion weighted (PW) parameter maps perform better in tissue at risk prediction and which parameters and thresholds should be used to guide treatment decisions.
In a group of 22 acute stroke patients with consecutive MR and quantitative positron emission tomography (PET) imaging, non-deconvolved parameters were validated with the gold standard for penumbral-flow (PF) detection 15O-water PET. Performance of PW parameters was assessed by a receiver operating characteristic curve analysis to identify the accuracy of each PWI map to detect the -upper PF threshold as defined by PET cerebral blood flow <20 mL/100 g/min.
Among normalized non-deconvolved parameters, PW-first moment without delay correction (FM without DC) > 3.6 s (area under the curve [AUC] = 0.89, interquartile range [IQR] 0.85-0.94), PW-maximum of the concentration curve (Cmax) < 0.66 (AUC = 0.92, IQR 0.84-0.96) and PW-time to peak (TTP) > 4.0 s (AUC = 0.92, IQR 0.87-0.94) perform significantly better than other non-deconvolved parameters to detect the PF threshold as defined by PET.
Non-deconvolved parameters FM without DC, Cmax and TTP are an observer-independent alternative to established deconvolved parameters (e.g., Tmax) to guide treatment decisions in acute stroke.
在急性卒中中，基于磁共振（MR）成像的不匹配概念用于选择有梗死风险组织的患者进行再灌注治疗。然而，对于非去卷积或去卷积灌注加权（PW）参数图在预测有风险组织方面是否表现更好，以及应使用哪些参数和阈值来指导治疗决策存在争议。
在一组22例连续进行MR和定量正电子发射断层扫描（PET）成像的急性卒中患者中，用半暗带血流（PF）检测的金标准15O-水PET验证非去卷积参数。通过受试者工作特征曲线分析评估PW参数的性能，以确定每个PWI图检测PET脑血流量<20 mL/100 g/min所定义的上PF阈值的准确性。
在归一化的非去卷积参数中，无延迟校正的PW-一阶矩（FM无DC）>3.6秒（曲线下面积[AUC]=0.89，四分位间距[IQR]0.85-0.94）、浓度曲线的PW-最大值（Cmax）<0.66（AUC=0.92，IQR 0.84-0.96）和PW-达峰时间（TTP）>4.0秒（AUC=0.92，IQR 0.87-0.94）在检测PET所定义的PF阈值方面比其他非去卷积参数表现明显更好。
无延迟校正的FM、Cmax和TTP这些非去卷积参数是既定去卷积参数（如Tmax）的一种独立于观察者的替代方法，可用于指导急性卒中的治疗决策。
