前瞻性颅内狭窄患者脑血管反应性和梗死发展的纵向磁共振成像评估。
A Prospective, Longitudinal Magnetic Resonance Imaging Evaluation of Cerebrovascular Reactivity and Infarct Development in Patients With Intracranial Stenosis.
机构信息
Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA.
Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Magn Reson Imaging. 2021 Sep;54(3):912-922. doi: 10.1002/jmri.27605. Epub 2021 Mar 24.
BACKGROUND
Patients with symptomatic atherosclerotic and non-atherosclerotic (i.e., moyamoya) intracranial steno-occlusive disease experience high 2-year infarct rates.
PURPOSE
To investigate whether cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) measures may provide biomarkers of 1-to-2-year infarct risk.
STUDY TYPE
Prospective, longitudinal study.
SUBJECTS
Adult participants (age = 18-85 years) with symptomatic intracranial atherosclerotic disease (N = 26) or non-atherosclerotic (i.e., moyamoya; N = 43) and stenosis ≥50% of a major intracranial artery were initially scanned within 45 days of stroke. Follow-up imaging (target = 1.5 years) was acquired for new infarct assessment.
FIELD STRENGTH/SEQUENCE: 3.0 Tesla with normocapnic arterial spin labeling (ASL) and blood oxygenation level-dependent (BOLD) imaging acquired during an interleaved hypercapnic (3 minutes) and normocapnic (3 minutes) respiratory stimulus.
ASSESSMENT
CBF, maximum CVR, and time-to-maximum CVR (i.e., CVR ) were calculated. Laterality indices (difference between infarcted and contralesional hemispheres divided by sum of absolute values) of metrics at enrollment were contrasted between participants with vs. without new infarcts on follow-up.
STATISTICAL TESTS
Laterality indices were compared using non-parametric Wilcoxon tests (significance: two-sided P < 0.05) and effect sizes as Cohen's d. Continuous variables are presented as mean ± SD.
RESULTS
New infarcts were observed on follow-up in 15.0% of participants. The laterality index of the CVR was elevated (P = 0.01) in participants with atherosclerosis with new infarcts (index = 0.13) compared to participants without new infarcts (index = 0.05).
DATA CONCLUSION
Elevated CVR may indicate brain parenchyma at increased risk for new infarcts in patients with symptomatic intracranial atherosclerotic disease treated with standard-of-care medical management.
LEVEL OF EVIDENCE
2 TECHNICAL EFFICACY STAGE: 3.
背景
有症状的动脉粥样硬化性和非动脉粥样硬化性（即 moyamoya）颅内狭窄闭塞性疾病患者，在 2 年内有较高的梗死发生率。
目的
研究脑血流（CBF）和脑血管反应性（CVR）测量值是否可以作为 1 至 2 年内梗死风险的生物标志物。
研究类型
前瞻性、纵向研究。
研究对象
患有症状性颅内动脉粥样硬化性疾病（n=26）或非动脉粥样硬化性（即 moyamoya；n=43）且主要颅内动脉狭窄≥50%的成年参与者（年龄为 18-85 岁），在中风后 45 天内进行初始扫描。进行随访成像（目标为 1.5 年）以评估新的梗死。
场强/序列：3.0 特斯拉，采用常氧动脉自旋标记（ASL）和血氧水平依赖（BOLD）成像，在交替的高碳酸（3 分钟）和常氧（3 分钟）呼吸刺激下采集。
评估
计算 CBF、最大 CVR 和达到最大 CVR 的时间（即 CVR）。在随访时，比较有无新发梗死的参与者的血管反应性测量值的偏侧性指数（梗死侧与对侧半球之间的差异除以绝对值之和）。
统计检验
使用非参数 Wilcoxon 检验（双侧 P<0.05）和 Cohen's d 比较偏侧性指数，并计算效应量。连续变量以平均值±标准差表示。
结果
在随访中，15.0%的参与者出现新发梗死。与无新发梗死的参与者相比，动脉粥样硬化伴新发梗死的参与者的 CVR 偏侧性指数升高（P=0.01）（指数=0.13）。
数据结论
在接受标准医疗管理的有症状颅内动脉粥样硬化性疾病患者中，升高的 CVR 可能表明脑实质有发生新梗死的风险增加。
证据水平
2 技术效能等级：3。
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