Reidler Paul, Mueller Franziska, Stueckelschweiger Lena, Feil Katharina, Kellert Lars, Fabritius Matthias P, Liebig Thomas, Tiedt Steffen, Puhr-Westerheide Daniel, Kunz Wolfgang G
Department of Radiology, University Hospital, LMU Munich, Germany.
Department of Neurology, University Hospital, LMU Munich, Germany.
Neuroimage Clin. 2020;27:102329. doi: 10.1016/j.nicl.2020.102329. Epub 2020 Jun 26.
Ipsilateral thalamic diaschisis (ITD) refers to the phenomenon of thalamic hypoperfusion or hypometabolism due to a distant cerebral injury. To further investigate the characteristics and spectrum of ITD, we analyzed quantitative measurements of thalamic hypoperfusion in acute anterior circulation stroke.
We selected consecutive patients with large-vessel occlusion (LVO) anterior circulation stroke and available CT perfusion (CTP) examination on admission who underwent endovascular thrombectomy. Thalamic perfusion parameters on CTP were tested between ipsi- and contralesional thalamus and ischemic territory. Values were compared with thresholds from CTP analysis software. Associations of thalamic perfusion parameters with acute imaging and clinical data were determined in uni- and multivariate logistic regression analyses.
Ninety-nine patients were included. All perfusion parameters indicated significant non-ischemic hypoperfusion of the thalamus, not reaching the levels of ischemia in the middle cerebral artery territory due to LVO (all p < 0.002). Multiple perfusion parameters exhibited significant association with ischemic lesion extent (relative cerebral blood flow [CBF]: β = - 0.23, p = 0.022; Δtime to drain: β = 0.33, p < 0.001; ΔTmax: β = - 0.36, p < 0.001) and involvement of the Lentiform Nucleus (Δmean transit time: β = 0.64, p = 0.04; Δtime to drain: β = 0.81, p = 0.01; ΔTmax: β = - 0.82, p = 0.01). Symptom severity on admission exhibited minor significant association with reduction of thalamic CBF in uncorrected analysis (Odds ratio: 0.05, p = 0.049), but short- and long-term outcomes were unaffected by perfusion status. ITD reached guideline-based software-threshold levels in only one patient.
ITD in acute stroke is a non-binary phenomenon affected by lesion extent and involvement of the lentiform nucleus. We found uncorrected association of ITD with early clinical presentation, but no association with short- or long-term outcome was evident. Relevant misclassification of ITD by guideline-based CTP software was not indicated, which needs further dedicated testing.
同侧丘脑远隔性机能障碍（ITD）是指因远处脑损伤导致的丘脑灌注不足或代谢减低现象。为进一步研究ITD的特征和范围，我们分析了急性前循环卒中时丘脑灌注不足的定量测量结果。
我们选取了连续的前循环大血管闭塞（LVO）性卒中患者，这些患者入院时接受了CT灌注（CTP）检查并接受了血管内血栓切除术。对CTP上的丘脑灌注参数在同侧和对侧丘脑以及缺血区域之间进行测试。将这些值与CTP分析软件的阈值进行比较。在单因素和多因素逻辑回归分析中确定丘脑灌注参数与急性影像学和临床数据之间的关联。
共纳入99例患者。所有灌注参数均表明丘脑存在明显的非缺血性灌注不足，未达到因LVO导致的大脑中动脉区域的缺血水平（所有p<0.002）。多个灌注参数与缺血性病变范围（相对脑血流量[CBF]：β=-0.23，p=0.022；引流时间差：β=0.33，p<0.001；最大峰值时间差：β=-0.36，p<0.001）以及豆状核受累情况（平均通过时间差：β=0.64，p=0.04；引流时间差：β=0.81，p=0.01；最大峰值时间差：β=-0.82，p=0.01）显著相关。在未校正分析中，入院时的症状严重程度与丘脑CBF降低存在轻微显著关联（比值比：0.05，p=0.049），但短期和长期预后不受灌注状态影响。仅1例患者的ITD达到基于指南的软件阈值水平。
急性卒中中的ITD是一种受病变范围和豆状核受累情况影响的非二元现象。我们发现ITD与早期临床表现存在未校正的关联，但与短期或长期预后无明显关联。未显示基于指南的CTP软件对ITD的相关错误分类情况，这需要进一步专门测试。
