合成 T2 映射与中风发病时间相关：苏醒性中风管理的未来工具？
Synthetic T2 mapping is correlated with time from stroke onset: a future tool in wake-up stroke management?
机构信息
Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France.
Biostatistics Department - Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France.
出版信息
Eur Radiol. 2019 Dec;29(12):7019-7026. doi: 10.1007/s00330-019-06270-0. Epub 2019 May 28.
OBJECTIVES
FLAIR-DWI mismatch is an effective method to select eligible wake-up stroke (WUS) patients for intravenous thrombolysis, but shows limitations in the case of subtle FLAIR hyperintensities. T2 mapping is a quantitative method, directly generated from synthetic MRI, which provides T2 relaxation times. We aimed to assess the correlation between T2 values and onset time in acute stroke patients.
METHODS
We prospectively included stroke patients in the 4.5-h window undergoing brain MRI including MAGnetic resonance Image Compilation (MAGiC) from March to October 2017. T2 relaxation times and FLAIR signal intensities were measured in ischemic and contralateral nonischemic regions to calculate FLAIR signal intensity ratio (rSI), difference, and ratio of T2 values. Correlation analysis with time from the onset was achieved using Pearson or Spearman correlation coefficient (ρ) test.
RESULTS
Forty-two patients were included. The strongest correlation with the time from onset was the difference in T2 relaxation times (ρ = 0.71; CI95% = [0.48; 0.85]), followed by the ratio (ρ = 0.65; CI95% = [0.37; 0.82]) and the absolute T2 relaxation time (ρ = 0.4; CI95% = [0.06; 0.66]), whereas the FLAIR rSI showed the weakest correlation (ρ = 0.18; CI95% = [- 0.16-0.51]).
CONCLUSIONS
The difference and ratio in T2 relaxation times were correlated with the onset time in stroke patients in the 4.5-h window. T2 mapping generated from synthetic MRI may become a relevant tool to select WUS patients with subtle FLAIR hyperintensities. Given that no definitive statement can be made about its usefulness in the 4.5-h windows, further study including patients with an onset time > 4.5 h is required.
KEY POINTS
• The difference and ratio in T2 relaxation times are each individually correlated with the time from stroke onset in the 4.5-h window. • FLAIR rSI showed a poor correlation with the time from stroke onset. • T2 mapping, directly generated from synthetic MRI, may be a suitable quantitative marker to select safely WUS patients with subtle FLAIR hyperintensities for intravenous thrombolysis.
目的
FLAIR-DWI 不匹配是选择适合静脉溶栓的清醒卒中（WUS）患者的有效方法，但在存在细微 FLAIR 高信号的情况下存在局限性。T2 映射是一种定量方法，直接从合成 MRI 生成，提供 T2 弛豫时间。我们旨在评估急性卒中患者 T2 值与发病时间之间的相关性。
方法
我们前瞻性纳入 2017 年 3 月至 10 月期间接受包括 MAGnetic resonance Image Compilation（MAGiC）在内的脑 MRI 检查、发病时间在 4.5 小时窗内的卒中患者。在缺血和对侧非缺血区域测量 T2 弛豫时间和 FLAIR 信号强度，以计算 FLAIR 信号强度比（rSI）、差值和 T2 值比。使用 Pearson 或 Spearman 相关系数（ρ）检验与发病时间的相关性分析。
结果
共纳入 42 例患者。与发病时间相关性最强的是 T2 弛豫时间的差值（ρ=0.71；95%CI95%=[0.48；0.85]），其次是比值（ρ=0.65；95%CI95%=[0.37；0.82]）和绝对 T2 弛豫时间（ρ=0.4；95%CI95%=[0.06；0.66]），而 FLAIR rSI 相关性最弱（ρ=0.18；95%CI95%=[−0.16；0.51]）。
结论
在 4.5 小时窗内的卒中患者中，T2 弛豫时间的差值和比值与发病时间相关。从合成 MRI 生成的 T2 图可能成为选择存在细微 FLAIR 高信号的 WUS 患者的一种相关工具。鉴于在 4.5 小时窗内其有用性尚不能得出明确结论，需要进一步纳入发病时间＞4.5 小时的患者进行研究。
关键点
在 4.5 小时窗内，T2 弛豫时间的差值和比值分别与卒中发病时间呈正相关。
FLAIR rSI 与卒中发病时间相关性差。
直接从合成 MRI 生成的 T2 映射可能是一种合适的定量标记物，用于选择可安全进行静脉溶栓治疗的存在细微 FLAIR 高信号的 WUS 患者。
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