Stanford University, Departments of Neurology.
Stanford University, Departments of Neurology.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106208. doi: 10.1016/j.jstrokecerebrovasdis.2021.106208. Epub 2021 Nov 22.
This study evaluated the associations of perfusion imaging collateral profiles with radiographic and clinical outcome in late presenting, non-reperfused patients in the DEFUSE 3 clinical trial.
Non-reperfused patients in both treatment arms were included. Baseline ischemic core, Tmax >6s, and Tmax >10s perfusion volumes were calculated with RAPID software; infarct volumes obtained 24 hours after randomization were manually determined from DWI or CT. Substantial infarct growth was defined as a >25mL increase between baseline and 24-hour follow-up. Hypoperfusion Intensity Ratio (HIR) was defined as the proportion of the Tmax >6s lesion with Tmax >10s delay; CBV index was calculated by RAPID from mean CBV values within the Tmax >6s lesion compared to regions of normal CBV.
Eighty-four patients were included. ROC analysis showed HIR ≥0.34 (AUC=0.68) and CBV index ≤0.74 (AUC=0.72) optimally predicted substantial infarct growth in follow-up. Median growth was 23.4 versus 73.2mL with HIR threshold of 0.34 (p=0.005), and 24.3 versus 58.7mL with CBV index threshold of 0.74 (p=0.004). If baseline HIR and CBV index were both favorable, median growth was 21.7mL, 40.9mL if one was favorable, and 108.2mL if both were unfavorable (p<0.001). Baseline perfusion profile was not associated with 90-day functional outcome.
Perfusion collateral scores forecast infarct growth in late presenting, non-reperfused ischemic stroke patients. These parameters may be useful for guiding transfer decisions, such as need for repeat imaging upon thrombectomy center arrival, and may help identify slow progressing patients more likely to have persistent salvageable ischemic tissue beyond 24 hours.
本研究评估了在 DEFUSE 3 临床试验中，延迟出现且未再通的患者的灌注成像侧支谱与影像学和临床结局的相关性。
纳入了两个治疗组的未再通患者。使用 RAPID 软件计算基线缺血核心、Tmax＞6s 和 Tmax＞10s 的灌注体积；随机分组后 24 小时获得的梗死体积通过 DWI 或 CT 手动确定。大量梗死进展定义为基线与 24 小时随访之间增加＞25mL。低灌注强度比（HIR）定义为 Tmax＞6s 病变中 Tmax＞10s 延迟的比例；通过 RAPID 从 Tmax＞6s 病变内的平均 CBV 值与正常 CBV 区域计算 CBV 指数。
共纳入 84 例患者。ROC 分析显示，HIR≥0.34（AUC=0.68）和 CBV 指数≤0.74（AUC=0.72）最佳预测随访中的大量梗死进展。HIR 阈值为 0.34 时，中位数增长为 23.4 与 73.2mL（p=0.005），CBV 指数阈值为 0.74 时，中位数增长为 24.3 与 58.7mL（p=0.004）。如果基线 HIR 和 CBV 指数均良好，中位数增长为 21.7mL，如果其中一个良好，中位数增长为 40.9mL，如果两者均不佳，中位数增长为 108.2mL（p＜0.001）。基线灌注谱与 90 天功能结局无关。
灌注侧支评分可预测延迟出现且未再通的缺血性脑卒中患者的梗死进展。这些参数可能有助于指导转院决策，例如在到达取栓中心后是否需要重复成像，并且可能有助于识别进展缓慢的患者，这些患者在 24 小时后可能有持续可挽救的缺血组织。
