Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
J Neuroimaging. 2020 May;30(3):321-326. doi: 10.1111/jon.12695. Epub 2020 Feb 10.
Imaging-based selection of stroke patients for endovascular thrombectomy (EVT) remains an ongoing challenge. Our aim was to determine the value of a combined parameter of ischemic core volume (ICV) and the relative degree of cerebral blood flow in the penumbra for morphologic and clinical outcome prediction.
In this Institutional Review Board (IRB)-approved prospective observational study, 221 consecutive patients with large vessel occlusion anterior circulation stroke within 6 hours of symptom onset and subsequent EVT were included between June 2015 and August 2017. Admission computed tomography perfusion was analyzed using automated threshold-based algorithms. Perfusion-weighted ICV (pw-ICV) was calculated by multiplying ICV with the relative cerebral blood flow reduction within the penumbra. Functional outcome was assessed by standardized assessment of the modified Rankin scale (mRS) after 3 months.
In multivariate analyses, pw-ICV was significantly associated with final infarction volume (FIV) (β = .38, P < .001) after adjustment for penumbra volume, age, sex and time from symptom onset. In separate multivariate analysis with either pw-ICV or ICV, pw-ICV outperformed ICV for the prediction of FIV (Akaike's information criterion: 1,072 vs. 1,089; conditional variable importance: 1,494 vs. 955). There was also a highly significant association between FIV and clinical outcome as measured by an mRS score of 2 or less (odds ratio per 10 mL = .78, P < .001). Both pw-ICV and ICV were significantly associated with NIHSS improvement (both P<.05).
In EVT-treated stroke patients, pw-ICV outperforms the more commonly used ICV in the prediction of morphological and functional outcome.
基于影像学的选择适合血管内血栓切除术（EVT）的卒中患者仍然是一个持续存在的挑战。我们的目的是确定缺血核心体积（ICV）和半影区相对脑血流程度的综合参数对形态和临床预后预测的价值。
在这项经过机构审查委员会（IRB）批准的前瞻性观察性研究中，纳入了 2015 年 6 月至 2017 年 8 月期间发病 6 小时内出现大血管闭塞性前循环卒中并随后接受 EVT 的 221 例连续患者。使用基于自动阈值的算法分析入院时的 CT 灌注。通过将 ICV 乘以半影区内相对脑血流减少程度来计算灌注加权 ICV（pw-ICV）。通过 3 个月后的改良 Rankin 量表（mRS）的标准化评估来评估功能结果。
在多变量分析中，在调整了半影区体积、年龄、性别和发病至治疗时间后，pw-ICV 与最终梗死体积（FIV）显著相关（β=.38，P <.001）。在单独的使用 pw-ICV 或 ICV 的多变量分析中，pw-ICV 优于 ICV 预测 FIV（Akaike 的信息量标准：1,072 对 1,089；条件变量重要性：1,494 对 955）。FIV 与通过 mRS 评分 2 或更低来衡量的临床结果之间也存在高度显著的相关性（每增加 10 mL 的优势比=.78，P <.001）。pw-ICV 和 ICV 均与 NIHSS 改善显著相关（均 P<.05）。
在接受 EVT 治疗的卒中患者中，pw-ICV 在预测形态和功能预后方面优于更常用的 ICV。
