Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Cereb Blood Flow Metab. 2020 Feb;40(2):437-445. doi: 10.1177/0271678X18823601. Epub 2019 Jan 10.
Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and ΔNWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) ΔNWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization ( < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered ΔNWU by 6.3% compared to LVO (95% confidence interval: 3.7-9.0, < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.
研究评估了再灌注对急性卒中缺血性水肿的影响，结果描述相互矛盾。脑容积单位的净水分摄取量（NWU）是一种新的占位性缺血性水肿的定量影像学生物标志物，可以在计算机断层扫描（CT）中测量。我们旨在使用定量 NWU 研究血管再通对缺血性脑水肿形成的影响。在这项多中心观察性研究中，连续筛选了前循环大血管闭塞（LVO）的急性缺血性卒中患者。比较了血管再通（血栓溶解治疗脑梗死（TICI）2b 或 3）与持续血管闭塞（无取栓术，TICI 0-1）的患者。在多模态入院 CT 和随访 CT（FCT）中定量测量病变-NWU，并计算 ΔNWU 作为差异。194 例患者中，150 例成功进行了血管内再通，44 例持续 LVO。在治疗后的 FCT 中，持续 LVO 患者的平均（标准差）ΔNWU 为 15.8%（5.7），血管再通患者为 9.8%（5.8）（<0.001）。多变量回归分析表明，与 LVO 相比，血管再通独立地使 ΔNWU 降低 6.3%（95%置信区间：3.7-9.0，<0.001）。成功的血管再通与缺血性脑水肿形成显著减少相关。定量 NWU 可用于比较急性卒中的治疗效果。
