脑白质疏松症可能会影响接受机械取栓治疗的急性缺血性脑卒中患者 CT 灌注的解读。
Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke.
机构信息
From the Department of Neuroscience (S.R., C.L., X.U., L.L., A.R., V.O., Y.Z., S.A., Á.C.)., Comprehensive Stroke Center, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Neurosurgery Service (C.V.), Universitary Hospital La Paz, Madrid, Spain.
出版信息
AJNR Am J Neuroradiol. 2019 Aug;40(8):1323-1329. doi: 10.3174/ajnr.A6139. Epub 2019 Jul 25.
BACKGROUND AND PURPOSE
Leukoaraiosis frequently coexists in patients with acute stroke. We studied whether leukoaraiosis could confound the interpretation of CTP findings in patients treated with mechanical thrombectomy.
MATERIALS AND METHODS
We analyzed 236 patients with stroke treated with mechanical thrombectomy and studied with CTP, of whom 127 (53.8%) achieved complete reperfusion. Periventricular white matter hyperintensities on MR imaging and hypodensities on NCCT were assessed through the Fazekas score. CTP-predicted nonviable tissue was defined as relative CBF <30%, and final infarct volume was quantified in DWI. We estimated mean MTT, CBV, and CBF in the asymptomatic hemisphere. In patients achieving complete reperfusion, we assessed the accuracy of nonviable tissue to predict final infarct volume using the intraclass correlation coefficient across periventricular hyperintensity/hypodensity Fazekas scores and variable relative CBF cutoffs.
RESULTS
MTT was longer (Spearman ρ = 0.279, < .001) and CBF was lower (ρ = -0.263, < .001) as the periventricular hyperintensity Fazekas score increased, while CBV was similar across groups (ρ = -0.043, = .513). In the subgroup of patients achieving complete reperfusion, nonviable tissue-final infarct volume reliability was excellent in patients with periventricular hyperintensity Fazekas score grade 0 (intraclass correlation coefficient, 0.900; 95% CI, 0.805-0.950), fair in patients with periventricular hyperintensity Fazekas scores 1 (intraclass correlation coefficient, 0.569; 95% CI, 0.327-0.741) and 2 (intraclass correlation coefficient, 0.444; 95% CI, 0.165-0.657), and poor in patients with periventricular hyperintensity Fazekas score 3 (intraclass correlation coefficient, 0.310; 95% CI, -0.359-0.769). The most accurate cutoffs were relative CBF <30% for periventricular hyperintensity Fazekas score grades 0 and 1, relative CBF <25% for periventricular hyperintensity Fazekas score 2, and relative CBF <20% for periventricular hyperintensity Fazekas score 3. The reliability analysis according to periventricular hypodensity Fazekas score grades on NCCT was similar to that in follow-up MR imaging.
CONCLUSIONS
In patients with stroke, the presence of leukoaraiosis confounds the interpretation of CTP despite proper adjustment of CBF thresholds.
背景与目的
在急性卒中患者中，脑白质疏松症常同时存在。本研究旨在探讨脑白质疏松症是否会影响接受机械取栓治疗的患者的 CTP 检查结果解读。
材料与方法
本研究分析了 236 例接受机械取栓治疗且接受 CTP 检查的卒中患者，其中 127 例（53.8%）达到完全再灌注。通过 Fazekas 评分评估磁共振成像上的脑室周围白质高信号和 NCCT 上的低信号。CTP 预测的无活力组织定义为相对 CBF＜30%，并在 DWI 上量化最终梗死体积。我们估计无症状侧的平均 MTT、CBV 和 CBF。在达到完全再灌注的患者中，我们使用基于 Periventricular Hyperintensity/Hypodensity Fazekas 评分和可变相对 CBF 截断值的内类相关系数评估无活力组织对最终梗死体积的预测准确性。
结果
随着脑室周围高信号 Fazekas 评分的增加，MTT 延长（Spearman ρ=0.279，＜.001），CBF 降低（ρ=-0.263，＜.001），而 CBV 在各组之间相似（ρ=-0.043，=.513）。在达到完全再灌注的患者亚组中，无活力组织与最终梗死体积的可靠性在脑室周围高信号 Fazekas 评分 0 级患者中极好（组内相关系数，0.900；95%置信区间，0.805-0.950），在脑室周围高信号 Fazekas 评分 1 级（组内相关系数，0.569；95%置信区间，0.327-0.741）和 2 级（组内相关系数，0.444；95%置信区间，0.165-0.657）患者中良好，在脑室周围高信号 Fazekas 评分 3 级患者中较差（组内相关系数，0.310；95%置信区间，-0.359-0.769）。最准确的截断值为脑室周围高信号 Fazekas 评分 0 级和 1 级为相对 CBF＜30%，脑室周围高信号 Fazekas 评分 2 级为相对 CBF＜25%，脑室周围高信号 Fazekas 评分 3 级为相对 CBF＜20%。根据 NCCT 上的脑室周围低信号 Fazekas 评分分级进行的可靠性分析与随访磁共振成像相似。
结论
在卒中患者中，即使适当调整 CBF 阈值，脑白质疏松症的存在也会影响 CTP 检查结果的解读。
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