Radiology Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270 Saint-Priest-En-Jarez, France.
Neurology Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270 Saint-Priest-En-Jarez, France.
J Neuroradiol. 2023 May;50(3):281-287. doi: 10.1016/j.neurad.2022.03.012. Epub 2022 Apr 3.
Classification of deep (D), superficial (S) MCA territories and their junctional vascular area (the internal border zone, IBZ) can help to identify patients most likely to benefit from aggressive reperfusion therapy after stroke. We tested the prognostic value of an IBZ injury compared to DWI-ASPECTS and infarct volume.
DW lesions of 168 patients with acute (4.2±6.5 h) MCA strokes were retrospectively examined and manually delineated. Patients with haemorrhagic transformation or other neurological diseases were excluded. Clinical data were recorded within 24 h following symptom onset and 48 h for patients who benefited from reperfusion therapy. The occurrence of an IBZ injury was determined using a standardized stereotaxic atlas. Performance to predict a good outcome (mRS<3 at 3 months) was estimated through ROC curves for DWI-ASPECTS≤6, lesion volume≥100 mL and IBZ injury. Logistic regression models were performed to estimate independent outcomes for infarct volume and IBZ injury.
Infarcts involving the IBZ were larger (94.9±98.8 mL vs. 30.2±31.3 mL), had higher NIHSS (13.8±7.2 vs. 7.2±5.7), more frequent MCA occlusions (64.9% vs. 28.3%), and worse outcomes (mRS 3.0±1.8 vs. 1.9±1.7), and were less responsive to IVtPA (34±47% vs. 55±48% of NIHSS improvement). The area under the ROC curves was comparable between the occurrence of IBZ injury (0.651), ASPECTS≤6 (0.657) and volume≥100 mL (0.629). Logistic regression analyses showed an independent effect of an IBZ injury, especially for superficial MCA strokes and for patients who benefited from reperfusion therapy.
An IBZ injury is an early and independent marker of stroke severity, functional prognosis and treatment responsiveness.
对大脑中动脉深（D）、浅（S）区及其交界区血管（内边界区，IBZ）进行分类有助于识别卒中后最有可能从积极再灌注治疗中获益的患者。我们比较了 IBZ 损伤与 DWI-ASPECTS 和梗死体积对预后的预测价值。
回顾性分析 168 例急性（4.2±6.5 h）大脑中动脉卒中患者的弥散加权成像（DW）病灶，并进行手动勾画。排除有出血性转化或其他神经疾病的患者。在症状出现后 24 小时内记录临床数据，对接受再灌注治疗的患者在 48 小时内进行记录。采用标准化立体定向图谱确定 IBZ 损伤的发生。通过 ROC 曲线评估 DWI-ASPECTS≤6、病灶体积≥100ml 和 IBZ 损伤对预测良好结局（3 个月 mRS<3）的效能。对梗死体积和 IBZ 损伤的独立预后进行 logistic 回归分析。
IBZ 受累的梗死灶更大（94.9±98.8ml 比 30.2±31.3ml），NIHSS 评分更高（13.8±7.2 比 7.2±5.7），MCA 闭塞更常见（64.9% 比 28.3%），预后更差（mRS 3.0±1.8 比 1.9±1.7），对 IVtPA 的反应更差（NIHSS 改善 34±47% 比 55±48%）。ROC 曲线下面积在 IBZ 损伤（0.651）、ASPECTS≤6（0.657）和体积≥100ml（0.629）之间无显著差异。logistic 回归分析显示 IBZ 损伤具有独立的预后意义，特别是对浅表 MCA 卒中患者和接受再灌注治疗的患者。
IBZ 损伤是卒中严重程度、功能预后和治疗反应的早期且独立的标志物。
