Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Eur Radiol. 2020 Dec;30(12):6421-6431. doi: 10.1007/s00330-020-07066-3. Epub 2020 Jul 16.
Early recanalization and adequate collateral blood flow are surrogates for functional recovery in endovascular stroke treatment (EVT). We evaluated the prognostic value of pre- and immediate post-thrombectomy perfusion-weighted magnetic resonance imaging (PWI) parameters.
Consecutive patients with acute ischemic stroke who underwent EVT were enrolled. Lesion volumes and their corresponding changes on diffusion-weighted (DWI) and PWI were assessed. Outcome was measured with modified Rankin Scale (mRS) at 90 days, and early neurological improvement (> 8 points improvement on National Institutes of Health Stroke Scale [NIHSS] or 0 to 1) at 7 days.
Fifty-two patients were enrolled. After control of initial NIHSS and recanalization status, post-thrombectomy time-to-peak (TTP) hypoperfused volume and TTP hypoperfused volume change remained independent predictors of favorable functional outcome (odds ratio [OR] = 0.13, 95% confidence interval [CI] = 0.03-0.54, p = 0.005; OR = 1.018, 95% CI = 1.00-1.03, p = 0.017), and early neurological improvement (OR = 0.20, 95% CI 0.07-0.58, p = 0.003; OR = 1.02, 95% CI = 1.00-1.03, p = 0.010). The areas under the curve of post-thrombectomy TTP hypoperfused volume and TTP hypoperfused volume change were 0.90 and 0.82 (cutoff 68 mL and 56 mL) for favorable outcome and 0.86 and 0.82 (cutoff 76 mL and 58 mL) for early neurological improvement, which had better prognostic values than other MR parameters and recanalization grades.
These results suggest a large amount of perfusion recovery on TTP is associated with favorable outcome as well as early neurological improvement after EVT, and may be a useful prognostic marker.
• A large amount of perfusion recovery on TTP map is associated with favorable outcome and early neurological improvement after EVT. • The best cutoff value for favorable functional outcome was 68 mL for post-EVT TTP hypoperfused volume and 56 mL decrease for TTP hypoperfused volume. • Amount of perfusion recovery on TTP map has better performance on the prediction of favorable functional recovery and early neurological improvement than other diffusion- and perfusion-weighted MRI parameters and recanalization grades.
血管内卒中治疗（EVT）中，早期再通和充分的侧支血流是功能恢复的替代指标。我们评估了血栓切除术前和即刻灌注加权磁共振成像（PWI）参数的预后价值。
连续纳入接受 EVT 的急性缺血性卒中患者。评估病变体积及其在弥散加权（DWI）和 PWI 上的相应变化。使用改良 Rankin 量表（mRS）在 90 天时测量结局，在 7 天时测量早期神经改善（NIHSS 改善>8 分或 0 至 1）。
共纳入 52 例患者。在控制初始 NIHSS 和再通状态后，血栓切除术后达峰时间（TTP）低灌注体积和 TTP 低灌注体积变化仍然是良好功能结局的独立预测因素（比值比[OR] = 0.13，95%置信区间[CI] = 0.03-0.54，p = 0.005；OR = 1.018，95% CI = 1.00-1.03，p = 0.017）和早期神经改善（OR = 0.20，95% CI 0.07-0.58，p = 0.003；OR = 1.02，95% CI = 1.00-1.03，p = 0.010）。血栓切除术后 TTP 低灌注体积和 TTP 低灌注体积变化的曲线下面积分别为 0.90 和 0.82（截断值为 68mL 和 56mL）用于良好结局，0.86 和 0.82（截断值为 76mL 和 58mL）用于早期神经改善，它们比其他 MR 参数和再通分级具有更好的预后价值。
这些结果表明，TTP 上大量灌注恢复与 EVT 后良好结局和早期神经改善有关，可能是一种有用的预后标志物。
• TTP 图上大量灌注恢复与 EVT 后良好结局和早期神经改善有关。
• 对于 TTP 低灌注体积，术后 TTP 低灌注体积的最佳截断值为 68mL，TTP 低灌注体积减少 56mL 为最佳截断值。
• TTP 图上的灌注恢复量在预测良好的功能恢复和早期神经改善方面比其他弥散和灌注加权 MRI 参数和再通分级具有更好的性能。
