Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
Department of Neurology, University of Cincinnati, Cincinnati, OH.
J Neuroimaging. 2019 Mar;29(2):203-205. doi: 10.1111/jon.12577. Epub 2018 Nov 6.
Impaired distal perfusion predicts neurological deterioration in large artery atherosclerosis. We aim to determine the optimal threshold of Tmax delay on perfusion imaging that is associated with neurological deterioration in patients with symptomatic proximal anterior circulation large artery stenosis.
Data were abstracted from a prospective ischemic stroke database of consecutively enrolled patients with symptomatic proximal intracranial stenosis (internal carotid artery or M1 segment of the middle cerebral artery) who underwent magnetic resonance perfusion imaging within 24 hours of symptom onset during a 15-month period. Tissue volumes of perfusion delay Tmax 0-4 seconds, Tmax > 4 seconds, Tmax > 6 seconds, and Tmax > 8 seconds were calculated using an automated approach. A target mismatch (penumbra-core) was defined as ≥15mL of brain tissue using each of the Tmax threshold categories. The outcome was neurological deterioration at 30 days defined as new or worsening neurological deficits that are not attributed to a nonvascular etiology.
Among 52 patients with symptomatic intracranial stenosis, 26 patients met inclusion criteria. Neurological deterioration was associated with target mismatch profile defined according to Tmax > 6 seconds (66.7% [6/9] vs. 5.9% [1/17], P < .01) and Tmax >8 seconds (57.1% [4/7] vs. 15.8% [3/19], P = .05] but not according to Tmax > 4 seconds (27.3% [6/17] vs. 11.1% [1/9], P = .35].
A target mismatch profile using Tmax > 6 seconds may define tissue at risk in patients with acute symptomatic proximal anterior circulation intracranial stenosis. More studies are needed to confirm our findings.
远端灌注受损可预测大动脉粥样硬化性病变的神经功能恶化。我们旨在确定与症状性前循环近端大血管狭窄患者神经功能恶化相关的灌注成像 Tmax 延迟最佳阈值。
从一项前瞻性缺血性卒中数据库中提取数据，该数据库纳入了在症状发作后 24 小时内接受磁共振灌注成像的连续入组的症状性近端颅内狭窄（颈内动脉或大脑中动脉 M1 段）患者。使用自动方法计算 Tmax 0-4 秒、Tmax>4 秒、Tmax>6 秒和 Tmax>8 秒的灌注延迟组织容积。使用每个 Tmax 阈值类别定义了≥15mL 的脑组织的靶失配（半影-核心）。结局为 30 天的神经功能恶化，定义为新出现或加重的神经功能缺损，且不能归因于非血管病因。
在 52 例症状性颅内狭窄患者中，26 例符合纳入标准。神经功能恶化与根据 Tmax>6 秒（66.7% [6/9] 比 5.9% [1/17]，P<.01）和 Tmax>8 秒（57.1% [4/7] 比 15.8% [3/19]，P=.05）定义的靶失配图谱相关，但与 Tmax>4 秒（27.3% [6/17] 比 11.1% [1/9]，P=.35）无关。
Tmax>6 秒的靶失配图谱可能定义了急性症状性前循环近端颅内狭窄患者的危险组织。需要更多的研究来证实我们的发现。
