Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia.
Monash Imaging, Monash Health, Clayton, Victoria, Australia.
Int J Stroke. 2020 Feb;15(2):216-225. doi: 10.1177/1747493019858781. Epub 2019 Jul 10.
The objective of this study was to compare the diagnostic performance of the baseline pre-contrast images of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) with conventional T2*gradient recalled echo (GRE) imaging for detection of hemorrhage in acute ischemic stroke patients.
T2GRE and DSC-PWI from 393 magnetic resonance imaging scans from 221 patients enrolled in three prospective stroke studies were independently evaluated by two readers blinded to clinical and other imaging data. Agreement between T2GRE and DSC-PWI for the presence of hemorrhage, and acute hemorrhagic transformation, was assessed using the kappa statistic. Inter-reader agreement was also assessed using the kappa statistic.
Agreement between the baseline images of DSC-PWI and T2GRE regarding the presence of hemorrhage was almost perfect (k : 0.90, 95% confidence interval 0.86-0.95 and k : 0.91, 95% confidence interval 0.87-0.96). Agreement between the sequences was still higher for detection of acute hemorrhagic transformation (k : 0.94, 95% confidence interval 0.91-0.98 and k : 0.95, 95% confidence interval 0.92-0.98). Inter-reader agreement for detection of hemorrhage was also almost perfect for both T2GRE (k: 0.95, 95% confidence interval 0.91-0.98) and DSC-PWI (k: 0.96, 95% confidence interval 0.93-0.99). Acute hemorrhagic transformation detected on T2*GRE was missed on DSC-PWI by one or both readers in 5/393 (1.3%) scans.
The almost perfect statistical agreement between DSC-PWI and conventional T2GRE suggests that DSC-PWI is sufficient for hemorrhage screening prior to thrombolysis in stroke patients. T2GRE can therefore be omitted when DSC-PWI is included, thereby shortening the acute ischemic stroke magnetic resonance imaging protocol and expediting treatment. ClinicalTrials.gov Identifier: NCT02586415.
本研究旨在比较动态磁敏感对比灌注加权成像（DSC-PWI）基线预对比图像与传统 T2*梯度回波（GRE）成像在急性缺血性卒中患者出血检测中的诊断性能。
对纳入三项前瞻性卒中研究的 221 名患者的 393 次磁共振成像扫描的 T2GRE 和 DSC-PWI 进行独立评估，评估者对临床和其他影像学数据不知情。采用κ 统计量评估 T2GRE 和 DSC-PWI 对出血和急性出血性转化的存在的一致性。采用κ 统计量评估读者间的一致性。
DSC-PWI 基线图像与 T2GRE 关于出血的存在的一致性几乎为完美（κ：0.90，95%置信区间 0.86-0.95 和 κ：0.91，95%置信区间 0.87-0.96）。两种序列对急性出血性转化的检测一致性更高（κ：0.94，95%置信区间 0.91-0.98 和 κ：0.95，95%置信区间 0.92-0.98）。对于 T2GRE（κ：0.95，95%置信区间 0.91-0.98）和 DSC-PWI（κ：0.96，95%置信区间 0.93-0.99），检测出血的读者间一致性也几乎为完美。在 393 次扫描中，有 5 次（1.3%）仅由一位或两位读者在 T2*GRE 上检测到的急性出血性转化在 DSC-PWI 上漏诊。
DSC-PWI 与传统 T2GRE 之间近乎完美的统计学一致性表明，在急性缺血性卒中患者溶栓前，DSC-PWI 足以进行出血筛查。因此，当包括 DSC-PWI 时，可以省略 T2GRE，从而缩短急性缺血性卒中磁共振成像方案并加快治疗速度。临床试验注册号：NCT02586415。
