Suh Chong Hyun, Jung Seung Chai, Cho Se Jin, Woo Dong-Cheol, Oh Woo Yong, Lee Jong Gu, Kim Kyung Won
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.
Acta Radiol. 2020 Jul;61(7):964-972. doi: 10.1177/0284185119887593. Epub 2019 Nov 18.
Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke.
The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke.
A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms "acute ischemic stroke," "hemorrhagic transformation," and "MRI." Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging.
Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61-93) and the pooled specificity was 79% (95% CI 71-85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82-0.88). Although study heterogeneity was present in both sensitivity (I=67.96%) and specificity (I=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70-98) and specificity of 78% (95% CI 65-87) to conventional MRI.
MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain.
出血性转化会增加急性缺血性脑卒中患者的死亡率和发病率。
本研究旨在评估磁共振成像（MRI）对急性缺血性脑卒中出血性转化的预测诊断性能。
截至2018年7月27日，对MEDLINE和EMBASE进行了系统的文献检索，检索词包括“急性缺血性脑卒中”、“出血性转化”和“MRI”。纳入评估MRI对急性缺血性脑卒中出血性转化预测诊断性能的研究。采用双变量随机效应模型进行诊断性荟萃分析，以计算合并敏感性和特异性。进行亚组分析，包括使用先进MRI技术（如灌注加权成像、扩散加权成像和磁敏感加权成像）的研究。
纳入9篇原始文章，共665例患者。出血性转化与高通透性、低灌注、低表观扩散系数（ADC）和液体衰减反转恢复序列（FLAIR）高信号有关。合并敏感性为82%（95%置信区间[CI]61-93），合并特异性为79%（95%CI 71-85）。分层汇总受试者工作特征曲线下面积为0.85（95%CI 0.82-0.88）。尽管敏感性（I=67.96%）和特异性（I=78.93%）均存在研究异质性，但证实存在阈值效应。使用先进MRI的研究显示，其对传统MRI的敏感性为92%（95%CI 70-98），特异性为78%（95%CI 65-87）。
MRI对预测急性缺血性脑卒中出血可能具有中等诊断性能，尽管这种出血的临床意义尚不确定。
