Xiao Jingjing, Liang Huazheng, Wang Yue, Wang Shaoshi, Wang Yi, Bi Yong
Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
Front Neurol. 2021 May 7;12:668360. doi: 10.3389/fneur.2021.668360. eCollection 2021.
Hypoperfusion is an important factor determining the prognosis of ischemic stroke patients. The present study aimed to investigate possible predictors of hypoperfusion on MRI of ischemic stroke patients within 7 days of stroke onset. Ischemic stroke patients, admitted to the comprehensive Stroke Center of Shanghai Fourth People's Hospital affiliated to Tongji University within 7 days of onset between January 2016 and June 2017, were recruited to the present study. Magnetic resonance imaging (MRI), including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days of the symptom onset. Time to maximum of the residue function ( ) maps were automatically evaluated using the RAPID software. The volume of hypoperfusion was measured outside the infarct area based on ADC < 620 × 10 mm/s. The 90 d mRS score was assessed through either clinic visits or telephone calls. Multivariate step-wise analysis was used to assess the correlation between MR findings and clinical variables, including the demographic information, cardio-metabolic characteristics, and functional outcomes. Among 635 patients admitted due to acute ischemic stroke within 7 days of onset, 241 met the inclusion criteria. Hypoperfusion volume of 38 ml was the best cut-off value for predicting poor prognosis of patients with cerebral infarction (90 d-mRS score ≥ 2). The incidences of MR perfusion > 4-6 s maps with a volume of 0-38 mL or >38 mL were 51.9% (125/241) and 48.1% (116/241), respectively. Prior stroke and vascular stenosis (≥70%) were associated with MR hypoperfusion. Multivariate step-wise analysis showed that prior stroke and vascular stenosis (≥70%) were risk factors of > 4-6 s maps, and the odds ratios (OR) were 3.418 (adjusted OR 95% CI: 1.537-7.600), and 2.265 (adjusted OR, 95% CI: 1.199-4.278), respectively. Our results suggest that prior stroke and vascular stenosis (≥70%) are strong predictors of hypoperfusion in patients with acute ischemic stroke within 7 days of stroke onset.
低灌注是决定缺血性脑卒中患者预后的重要因素。本研究旨在探讨卒中发病7天内缺血性脑卒中患者MRI上低灌注的可能预测因素。选取2016年1月至2017年6月期间发病7天内入住同济大学附属上海市第四人民医院综合卒中中心的缺血性脑卒中患者纳入本研究。在症状发作7天内进行磁共振成像（MRI）检查，包括弥散加权成像（DWI）和灌注加权成像（PWI）。使用RAPID软件自动评估残余函数（ ）图的最大时间。基于表观扩散系数（ADC）<620×10⁻⁶mm²/s在梗死区外测量低灌注体积。通过门诊就诊或电话随访评估90天改良Rankin量表（mRS）评分。采用多因素逐步分析评估MR表现与临床变量之间的相关性，包括人口统计学信息、心脏代谢特征和功能结局。在发病7天内因急性缺血性脑卒中入院的635例患者中，241例符合纳入标准。脑梗死患者（发病90天mRS评分≥2分）预后不良的最佳低灌注体积截断值为38ml。MR灌注 >4 - 6s图体积为0 - 38mL或>38mL的发生率分别为51.9%（125/241）和48.1%（116/241）。既往卒中史和血管狭窄（≥70%）与MR低灌注相关。多因素逐步分析显示，既往卒中史和血管狭窄（≥70%）是 >4 - 6s图的危险因素，比值比（OR）分别为3.418（校正OR 95%CI：1.537 - 7.600）和2.265（校正OR，95%CI：1.199 - 4.278）。我们的结果表明，既往卒中史和血管狭窄（≥70%）是卒中发病7天内急性缺血性脑卒中患者低灌注的强预测因素。
