Bourcier Romain, Duchmann Zoé, Sgreccia Alessandro, Desal Hubert, Carità Giuseppe, Desilles Jean Philippe, Lapergue Bertrand, Consoli Arturo
Department of Neuroradiology, University hospital of Nantes, Nantes France.
Department of Neuroradiology, University hospital of Nantes, Nantes France.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105245. doi: 10.1016/j.jstrokecerebrovasdis.2020.105245. Epub 2020 Aug 20.
The "white" compared to "Red-Black" visual aspect of the thrombus at withdrawal with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) was related to atypical etiologies like infective endocarditis. The susceptibility vessel sign (SVS) and the two-layered SVS (TL-SVS) could help predict outcome and cardio-embolic etiology of AIS. We aim to evaluate the diagnostic performance of the SVS and TLSVS to predict the visual aspect of the thrombus.
We included patients treated by MT and screened with MRI for the SVS and the TL-SVS for whom thrombus photograph was available. Photographs underwent a double-blind evaluation by neuroradiologists who classified the thrombus as "White" or "Red-Black". Logistic regression assessed the association of Red-Black thrombus and age, sex, baseline National Institutes of Health Stroke Scale, occlusion site, the IVr-tPA administration, SVS and TL-SVS. We calculated the diagnostic performances of the SVS to predict a Red-Black type thrombus.
Between May 2017 and July 2018, 139 patients were included in the study. On multivariate analysis, only SVS was an independent predictor for Red-Black thrombus (Odd ratio 8.31, 95%CI2.30 to 32, p value<0.001). Concerning SVS diagnostic performances, the specificity was 0.58 (95%CI0.28 to 0.85), the sensitivity was 0.87 (95%CI0.80 to 0.93), the negative predictive value was 0.30 (95% 0.13 to 0.53), the positive predictive value was 0.96 (95%CI0.90 to 0.99) and accuracy was 0.85 (95%CI0.78 to 0.90).
The SVS on MRI provides a good prediction accuracy to anticipate the macroscopic visual aspect of the thrombus after MT for AIS.
在急性缺血性卒中（AIS）的机械取栓术（MT）中，回撤时血栓呈现的“白色”相较于“红黑色”视觉特征与感染性心内膜炎等非典型病因相关。易损血管征（SVS）和双层易损血管征（TL-SVS）有助于预测AIS的预后和心源性栓塞病因。我们旨在评估SVS和TL-SVS预测血栓视觉特征的诊断效能。
我们纳入了接受MT治疗且通过MRI筛查SVS和TL-SVS且有血栓照片的患者。照片由神经放射科医生进行双盲评估，他们将血栓分类为“白色”或“红黑色”。逻辑回归分析评估红黑色血栓与年龄、性别、基线美国国立卫生研究院卒中量表、闭塞部位、静脉注射重组组织型纤溶酶原激活剂（IVr-tPA）、SVS和TL-SVS之间的关联。我们计算了SVS预测红黑色血栓类型的诊断效能。
2017年5月至2018年7月期间，139例患者纳入研究。多因素分析显示，只有SVS是红黑色血栓的独立预测因素（比值比8.31，95%置信区间2.30至32，p值<0.001）。关于SVS的诊断效能，特异性为0.58（95%置信区间0.28至0.85），敏感性为0.87（95%置信区间0.80至0.93），阴性预测值为0.30（95%置信区间0.13至0.53），阳性预测值为0.96（95%置信区间0.90至0.99），准确性为0.85（95%置信区间0.78至0.90）。
MRI上的SVS对预测AIS患者MT术后血栓的宏观视觉特征具有良好的准确性。
