Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R. Lemmens).
Department of Neurosciences, Experimental Neurology (L.S., A.W., R. Lemmens), KU Leuven-University of Leuven, Belgium.
Stroke. 2021 Jul;52(7):2338-2346. doi: 10.1161/STROKEAHA.120.033071. Epub 2021 May 13.
We aimed to investigate fluid-attenuated inversion recovery changes in the penumbra.
We determined core and perfusion lesions in subjects from the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke) and AXIS 2 trial (Granulocyte Colony-Stimulating Factor in Patients With Acute Ischemic Stroke) with perfusion- and diffusion-weighted imaging at baseline. Only subjects with a mismatch volume >15 mL and ratio >1.2 were included. We created voxel-based relative fluid-attenuated inversion recovery signal intensity (rFLAIR SI) maps at baseline and follow-up. We studied rFLAIR SI in 2 regions of interest: baseline penumbra (baseline perfusion lesion−[core lesion+voxels with apparent diffusion coefficient <620 10−6 mm2/s]) and noninfarcted penumbra (baseline perfusion lesion−follow-up fluid-attenuated inversion recovery lesion) at 24 hours (WAKE-UP) or 30 days (AXIS 2). We analyzed the association between rFLAIR SI and severity of hypoperfusion, defined as time to maximum of the residue function.
In the baseline penumbra, rFLAIR SI was elevated (ratio, 1.04; P=1.7×10−13; n=126) and correlated with severity of hypoperfusion (Pearson r, 0.03; P<1.0×10−4; n=126). In WAKE-UP, imaging at 24 hours revealed a further increase of rFLAIR SI in the noninfarcted penumbra (ratio, 1.05 at 24 hours versus 1.03 at baseline; P=7.1×10−3; n=43). In AXIS 2, imaging at 30 days identified reversibility of the rFLAIR SI (ratio, 1.02 at 30 days versus 1.04 at baseline; P=1.5×10−3; n=26) since it was no longer different from 1 (ratio, 1.01 at 30 days; P=0.099; n=26).
Penumbral rFLAIR SI increases appear early after stroke onset, correlate with severity of hypoperfusion, further increase at 24 hours, and are reversible by 30 days.
URL: https://clinicaltrials.gov; Unique identifier: NCT01525290. URL: https://clinicaltrials.gov; Unique identifier: NCT00927836.
本研究旨在探讨缺血半暗带的液体衰减反转恢复（FLAIR）信号改变。
我们在 WAKE-UP 试验（基于 MRI 的溶栓治疗在唤醒性中风中的疗效和安全性）和 AXIS 2 试验（急性缺血性卒中患者的粒细胞集落刺激因子）的受试者中使用灌注和弥散加权成像确定核心和灌注病变。仅纳入匹配体积＞15ml 和比值＞1.2 的受试者。我们在基线和随访时创建基于体素的相对 FLAIR 信号强度（rFLAIR SI）图。我们在 2 个感兴趣区域研究 rFLAIR SI：基线缺血半暗带（基线灌注病变−[核心病变+表观弥散系数＜620×10−6mm2/s 的体素]）和非梗死缺血半暗带（基线灌注病变−随访 FLAIR 病变），时间为 24 小时（WAKE-UP）或 30 天（AXIS 2）。我们分析 rFLAIR SI 与低灌注严重程度之间的关系，低灌注严重程度定义为残留功能的最大值时间。
在基线缺血半暗带中，rFLAIR SI 升高（比值为 1.04；P=1.7×10−13；n=126），与低灌注严重程度相关（Pearson r，0.03；P＜1.0×10−4；n=126）。在 WAKE-UP 中，24 小时的影像学检查显示非梗死缺血半暗带中 rFLAIR SI 进一步增加（比值为 24 小时时的 1.05 与基线时的 1.03；P=7.1×10−3；n=43）。在 AXIS 2 中，30 天的影像学检查发现 rFLAIR SI 具有可逆性（比值为 30 天时的 1.02 与基线时的 1.04；P=1.5×10−3；n=26），因为它不再与 1 不同（比值为 30 天时的 1.01；P=0.099；n=26）。
卒中发作后早期缺血半暗带的 rFLAIR SI 增加，与低灌注严重程度相关，24 小时时进一步增加，30 天时可逆转。
网址：https://clinicaltrials.gov；唯一标识符：NCT01525290. 网址：https://clinicaltrials.gov；唯一标识符：NCT00927836.
