Department ot Radiology University Hospital, LMU Munich Munich Germany.
Department of Neuroradiology University Hospital LMU Munich Germany.
J Am Heart Assoc. 2019 Nov 5;8(21):e013069. doi: 10.1161/JAHA.119.013069. Epub 2019 Oct 19.
Background The diagnosis of ischemic cerebellar stroke is challenging because of nonspecific symptoms and very limited accuracy of commonly applied computed tomography (CT) imaging. Advances in CT perfusion imaging provide increasing value in the detection of posterior circulation stroke, but the prognostic value remains unclear. We aimed to identify imaging parameters that predict morphologic outcome in cerebellar stroke patients using advanced CT including whole-brain CT perfusion (WB-CTP). Methods and Results We selected all subjects with cerebellar WB-CTP perfusion deficits and follow-up-confirmed cerebellar infarction from a consecutive cohort with suspected stroke who underwent WB-CTP. Posterior-circulation-Acute-Stroke-Prognosis-Early-CT-Score (pc-ASPECTS) was determined on noncontrast CT, CT angiography source images, and on parametric WB-CTP maps. Cerebellar perfusion deficit volumes on all maps and the final infarction volume on follow-up imaging were quantified. Uni- and multivariate regression analyses were performed. Sixty patients fulfilled the inclusion criteria. pc-ASPECTS on CT angiography source images (ß, -9.239; 95% CI, -14.220 to -4.259; <0.001) and cerebral blood flow deficit volume (ß, 0.886; 95% CI, 0.684 to 1.089; <0.001) were significantly associated with final infarction volume in univariate linear regression analysis. The association of cerebral blood flow deficit volume (ß, 0.830; 95% CI, 0.605-1.055; <0.001) was confirmed in a multivariate linear regression model adjusted for age, sex, pc-ASPECTS on noncontrast CT, and CT angiography source images and the National Institutes of Health Stroke Scale score on admission. No other clinical or imaging parameters were associated with cerebellar stroke final infarction volume (>0.05). Conclusions In contrast to noncontrast CT and CT angiography, WB-CTP imaging contains prognostic information for morphologic outcome in patients with acute cerebellar stroke.
由于非特异性症状和通常应用的计算机断层扫描（CT）成像的准确性非常有限，因此缺血性小脑卒中的诊断具有挑战性。CT 灌注成像的进步在后循环卒中的检测中提供了越来越大的价值，但预后价值仍不清楚。我们旨在使用包括全脑 CT 灌注（WB-CTP）在内的先进 CT 来识别可预测小脑卒中患者形态学结局的影像学参数。
我们从接受 WB-CTP 的疑似卒中连续队列中选择了所有具有小脑 WB-CTP 灌注缺损和随访证实的小脑梗死的患者。在非对比 CT、CT 血管造影源图像和参数化 WB-CTP 图上确定后循环急性卒中预后早期 CT 评分（pc-ASPECTS）。在所有图谱上量化小脑灌注缺损体积和随访成像上的最终梗死体积。进行了单变量和多变量回归分析。
60 例患者符合纳入标准。CT 血管造影源图像上的 pc-ASPECTS（β，-9.239；95%CI，-14.220 至-4.259；<0.001）和脑血流缺损体积（β，0.886；95%CI，0.684 至 1.089；<0.001）在单变量线性回归分析中与最终梗死体积显著相关。脑血流缺损体积（β，0.830；95%CI，0.605 至 1.055；<0.001）在调整非对比 CT 上的年龄、性别、pc-ASPECTS、CT 血管造影源图像和入院时的国立卫生研究院卒中量表评分的多变量线性回归模型中得到确认。没有其他临床或影像学参数与小脑卒中的最终梗死体积相关（>0.05）。
与非对比 CT 和 CT 血管造影相比，WB-CTP 成像包含急性小脑卒中患者形态学结局的预后信息。
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