Department of Neurosurgery, Kawachi General Hospital, Osaka, Japan.
Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan.
PLoS One. 2019 Jan 15;14(1):e0210709. doi: 10.1371/journal.pone.0210709. eCollection 2019.
This study aimed to elucidate spatial characteristics for magnetic resonance imaging (MRI) of cardiogenic cerebral embolism, to determine imaging biomarkers predicting patient outcome and cerebral herniation in cardioembolic stroke. This retrospective study assessed 90 patients with cardiogenic cerebral embolism. All images from MRI were normalized using a voxel-based symptom lesion mapping technique. Patients were categorized into two subgroups based on the outcome and presence of cerebral herniation. Each subgroup was assessed individually. The distribution map of all analyzed patients revealed accumulated ischemic lesions in bilateral middle cerebral artery areas. Ischemic lesions for the poor outcome group accumulated at the corona radiata on the right side and throughout the entire left hemisphere. Receiver operating characteristic (ROC) analysis suggested that a normalized ischemic volume of 62.8 mL allowed optimal differentiation between good and poor outcomes (sensitivity, 0.923; specificity, 0.923; area under the curve (AUC), 0.91) for left-side-dominant infarction. The distribution map for the cerebral herniation group revealed large ischemic areas in the left hemisphere. The analysis of differential involvement map with random permutation analysis showed that left anterior circulation infarcts were associated with midline shift. Receiver operating characteristic analysis revealed that a normalized infarction volume of 192.9 mL was highly predictive of cerebral herniation (sensitivity, 0.929; specificity, 0.750; AUC, 0.895). The medial frontal and occipital lobes, caudate head and basal ganglia were significantly involved in those patients who developed cerebral herniation. Ischemic volume contributed to outcomes and cerebral herniation. Ischemic lesions of the anterior and posterior cerebral arteries and basal ganglia in addition to middle cerebral artery area were identified as differences on MRI images between with and without cerebral herniation patients.
本研究旨在阐明心源脑栓塞磁共振成像（MRI）的空间特征，确定预测心源性脑栓塞患者结局和脑疝的影像学标志物。这项回顾性研究评估了 90 例心源脑栓塞患者。所有 MRI 图像均使用基于体素的症状病变映射技术进行归一化。根据结局和脑疝的存在，将患者分为两个亚组。分别评估每个亚组。所有分析患者的分布图显示双侧大脑中动脉区域存在累积缺血性病变。预后不良组的缺血性病变在右侧放射冠和整个左侧半球累积。受试者工作特征（ROC）分析表明，正常化缺血体积为 62.8ml 可最佳区分良好和不良结局（敏感性 0.923；特异性 0.923；曲线下面积（AUC）为 0.91），适用于左侧优势半球梗死。脑疝组的分布图显示左侧半球存在大面积缺血区。差异参与图的随机置换分析显示，左侧前循环梗死与中线移位相关。ROC 分析表明，正常化梗死体积 192.9ml 对脑疝具有高度预测性（敏感性 0.929；特异性 0.750；AUC 为 0.895）。额内侧和枕叶、尾状核头和基底节在发生脑疝的患者中明显受累。缺血体积与结局和脑疝有关。大脑前、后动脉和基底节除大脑中动脉区域外的缺血性病变被认为是有无脑疝患者 MRI 图像之间的差异。
