Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105528. doi: 10.1016/j.jstrokecerebrovasdis.2020.105528. Epub 2020 Dec 8.
White matter hyperintensity is common in patients receiving intravenous thrombolysis. Some studies have expressed concern about the increased risk of hemorrhagic transformation and poor prognosis for those patients with pre-existing leukoaraiosis. The purpose of this study was to evaluate hypoperfusion associated with leukoaraiosis before thrombolysis using CT perfusion and to explore whether chronic white matter hypoperfusion increases risks of intracranial hemorrhage and poor clinical prognosis.
We collected 175 patients underwent intravenous thrombolysis with complete CT perfusion data and follow-up MRI between June 2017 and January 2020. We measured cerebral blood flow, cerebral blood volume, mean transit time and transit time to the peak at both periventricular and subcortical layers in the cerebral hemisphere contralateral to the stroke. The differences of white matter perfusion were compared between groups with different leukoaraiosis severity. Univariate analysis was used to compare in incidence of hemorrhagic transformation and poor prognosis between the hypoperfusion and normal perfusion groups. Further, we examined association between white matter hypoperfusion and intracranial hemorrhage after thrombolysis using logistic regression.
The length of periventricular transit time to the peak was independently associated with a higher risk of intracranial hemorrhage after thrombolysis (OR=4.740, 95%CI=1.624-13.837, P=0.004). The best predictive value was 4.012. But there was no significant difference in poor prognosis at 3 months between hypoperfusion (periventricular transit time to the peak≥4.012 s) and normal perfusion (periventricular transit time to the peak<4.012 s) group.
Image presentations of white matter hypoperfusion reflected the severity of leukoaraiosis. White matter hypoperfusion was independently associated with intracranial hemorrhage after intravenous thrombolysis. However, hypoperfusion would not increase the risk of poor prognosis.
接受静脉溶栓治疗的患者中常见脑白质高信号。一些研究对存在脑白质疏松症的患者发生出血性转化和预后不良的风险增加表示担忧。本研究旨在通过 CT 灌注评估溶栓前与脑白质疏松症相关的低灌注，并探讨慢性脑白质低灌注是否会增加颅内出血和不良临床预后的风险。
我们收集了 2017 年 6 月至 2020 年 1 月期间 175 例接受静脉溶栓治疗且具有完整 CT 灌注数据和随访 MRI 的患者。我们测量了对侧大脑半球室周和皮质下白质区的脑血流量、脑血容量、平均通过时间和达峰时间。比较不同脑白质疏松症严重程度患者之间的脑白质灌注差异。采用单因素分析比较低灌注组和正常灌注组出血性转化和预后不良的发生率。进一步使用逻辑回归检查溶栓后脑白质低灌注与颅内出血之间的关系。
室周达峰通过时间与溶栓后颅内出血的风险独立相关（OR=4.740，95%CI=1.624-13.837，P=0.004）。最佳预测值为 4.012。但是，低灌注（室周达峰通过时间≥4.012 s）和正常灌注（室周达峰通过时间<4.012 s）组在 3 个月时的预后不良差异无统计学意义。
脑白质低灌注的影像学表现反映了脑白质疏松症的严重程度。脑白质低灌注与静脉溶栓后颅内出血独立相关。然而，低灌注不会增加预后不良的风险。
