急性缺血性脑卒中患者动脉自旋标记的早期神经恶化与低灌注容积比。
Early Neurological Deterioration and Hypoperfusion Volume Ratio on Arterial Spin Labeling in Patients with Acute Ischemic Stroke.
机构信息
Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu Province, China; Department of Neurology, Jinling Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Neurology, Jinling Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China.
出版信息
J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105885. doi: 10.1016/j.jstrokecerebrovasdis.2021.105885. Epub 2021 Jun 6.
BACKGROUND
Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique used to quantify cerebral blood perfusion by labeling blood water as it flows throughout the brain. Hypoperfusion volume ratio (HVR) can be calculated using proportional hypoperfusion volume on ASL-based cerebral blood flow (CBF). This study aimed to explore the relation between HVR and early neurological deterioration (END) in AIS patients.
SUBJECTS AND METHODS
Patients with AIS were recruited consecutively, and ASL and regular MRI scans were performed. HVR was calculated from 1.5 and 2.5s post labeling delay (PLD) ASL-CBF maps. END was defined as ≥2 points increment of NIHSS within 72 hours of stroke onset. Univariate and multivariate analysis were used to evaluate the relation between HVR and END. Receiver operating characteristic (ROC) curves were used to determine the ability of HVR in predicting END.
RESULTS
Of the 52 enrolled patients, 18 (34.5%) were determined with END. In patients with END, the median hypoperfusion volume was 20 mL [Inter Quartile Range)IQR, 6-72.5 mL] at 1.5s PLD, and 11.2 mL (IQR, 5.3-26 mL) at 2.5s PLD; Sixteen (88.9%) patients had HVR ≥50%, and 13 (72.2%) patients hypoperfusion volume at 2.5s PLD ASL were greater than diffusion-weighted imaging (DWI) infarct volume. In patients without END, median hypoperfusion volume was 7 mL (IQR, 4-30 mL) at 1.5s PLD, and 4 mL (IQR, 1.5-8.5 mL) at 2.5s; Eleven (32.4%) patients had HVR ≥50%, and 10 (29.4%) patients hypoperfusion volume at 2.5s PLD ASL were greater than DWI infarct volume. The proportion of HVR ≥50% and hypoperfusion volume >DWI infarct volume were more frequent in patients with END than patients without (all P<0.001). After adjusted for age, admission NIHSS, proportion of hypoperfusion volume > DWI infarct and arterial transit artifact (ATA) by logistic regression analysis, HVR ≥50% (OR=13.1, P=0.003) was an independent risk factor for END. ROC analysis demonstrated that the HVR could predict END with an area under the curve of 0.794 (P=0.001).
CONCLUSIONS
HVR obtained from the 1.5 and 2.5s PLD ASL may be a useful predictor of END in AIS. The value of HVR may be a marker for hemodynamic impairments.
背景
动脉自旋标记（ASL）是一种磁共振成像（MRI）技术，用于通过标记流经大脑的血液水来量化脑血流灌注。基于 ASL 的脑血流（CBF）的相对低灌注量（HVR）可以通过比例性低灌注量来计算。本研究旨在探讨 HVR 与急性缺血性脑卒中（AIS）患者早期神经功能恶化（END）之间的关系。
受试者和方法
连续招募 AIS 患者，并进行 ASL 和常规 MRI 扫描。HVR 是从 1.5 和 2.5 秒后标记延迟（PLD）ASL-CBF 图中计算得出的。END 定义为发病后 72 小时内 NIHSS 评分增加≥2 分。采用单因素和多因素分析评估 HVR 与 END 之间的关系。使用受试者工作特征（ROC）曲线确定 HVR 预测 END 的能力。
结果
在 52 名入组患者中，18 名（34.5%）被确定为 END。在 END 患者中，1.5s PLD 的中位低灌注量为 20ml[四分位间距（IQR），6-72.5ml]，2.5s PLD 的中位低灌注量为 11.2ml（IQR，5.3-26ml）；16 名（88.9%）患者 HVR≥50%，且 13 名（72.2%）患者的 2.5s PLD ASL 低灌注量大于弥散加权成像（DWI）梗死体积。在无 END 患者中，1.5s PLD 的中位低灌注量为 7ml（IQR，4-30ml），2.5s PLD 的中位低灌注量为 4ml（IQR，1.5-8.5ml）；11 名（32.4%）患者 HVR≥50%，且 10 名（29.4%）患者的 2.5s PLD ASL 低灌注量大于 DWI 梗死体积。与无 END 患者相比，有 END 患者的 HVR≥50%和低灌注量>DWI 梗死体积的比例更高（均 P<0.001）。经多因素逻辑回归分析校正年龄、入院 NIHSS、低灌注量>DWI 梗死体积的比例和动脉转运时间伪影（ATA）后，HVR≥50%（OR=13.1，P=0.003）是 END 的独立危险因素。ROC 分析表明，HVR 可预测 END，曲线下面积为 0.794（P=0.001）。
结论
1.5 和 2.5s PLD ASL 获得的 HVR 可能是 AIS 患者 END 的有用预测指标。HVR 的价值可能是血流动力学损伤的标志物。
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