Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
Medical Physics Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
J Neuroimaging. 2019 Mar;29(2):193-197. doi: 10.1111/jon.12569. Epub 2018 Oct 9.
This study aims to investigate the significance of regional hyperperfusion (RH) detected by arterial spin labeling (ASL) in a group of untreated stroke patients, within 24-36 hours after symptom onset. The relationship between RH volume and infarcted volume (DIV) as defined on diffusion weighted images (DWIs) was evaluated.
Of the 346 consecutive acute stroke patients who attended our center, we retrospectively reviewed MRI studies of 47 patients who were ineligible for standard treatment with intravenous tissue plasminogen activator. The MRI study included ASL and DWI. The ASL-derived cerebral blood flow (CBF) maps were coregistered on the DWI images. RH volume and DIV were calculated and compared. Patient NIHSS scores were also evaluated at admission, discharge, and after 1 and 6-month follow-up.
Twenty-two patients showed RH with CBF twice than baseline. In all 22 patients, RH overlaps with DWI infarcted area. No significant difference (P = .94) between RH volume and DIV was found (7.2 ± 9.6 and 9.0 ± 11.9 cm ). The Pearson's correlation coefficient between RH and DIV was .93. On univariate analysis, a significant difference was found between patient's groups on NIHSS at any time points, after covariates adjustment NIHSS difference was significant only at admission.
The study showed that ASL perfusion could be an integral part of the MRI examination in the assessment of 24-36 hours not-treated stroke patients as sustained RH group had improved outcomes. More importantly, ASL perfusion may provide evidence of beneficial effects of reperfusion induced by recanalization treatment.
本研究旨在探讨动脉自旋标记（ASL）检测到的区域过度灌注（RH）在一组未经治疗的中风患者中的意义，这些患者在症状发作后 24-36 小时内。评估 RH 体积与弥散加权图像（DWIs）定义的梗死体积（DIV）之间的关系。
在 346 例连续急性中风患者中，我们回顾性分析了 47 例不符合标准静脉组织型纤溶酶原激活剂治疗的患者的 MRI 研究。MRI 研究包括 ASL 和 DWI。ASL 衍生的脑血流（CBF）图与 DWI 图像配准。计算并比较 RH 体积和 DIV。还在入院、出院以及 1 个月和 6 个月随访时评估患者 NIHSS 评分。
22 例患者出现 CBF 是基线的两倍的 RH。在所有 22 例患者中，RH 与 DWI 梗死区重叠。RH 体积与 DIV 之间无显著差异（P =.94）（7.2 ± 9.6 和 9.0 ± 11.9 cm ）。RH 与 DIV 之间的 Pearson 相关系数为 0.93。在单变量分析中，在任何时间点 NIHSS 患者组之间存在显著差异，在协变量调整后，只有入院时 NIHSS 差异有统计学意义。
该研究表明，ASL 灌注可以成为 24-36 小时未经治疗中风患者 MRI 评估的一个组成部分，因为持续 RH 组的预后改善。更重要的是，ASL 灌注可能为再通治疗引起的再灌注的有益效果提供证据。
