基于 CT 灌注的随访梗死核心估计的准确性：距最后一次已知健康时间的影响。
Accuracy of CT Perfusion-Based Core Estimation of Follow-up Infarction: Effects of Time Since Last Known Well.
机构信息
From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH.
出版信息
Neurology. 2022 May 24;98(21):e2084-e2096. doi: 10.1212/WNL.0000000000200269. Epub 2022 Apr 21.
BACKGROUND AND OBJECTIVES
To assess the accuracy of baseline CT perfusion (CTP) ischemic core estimates.
METHODS
From SELECT (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke), a prospective multicenter cohort study of imaging selection, patients undergoing endovascular thrombectomy who achieved complete reperfusion (modified Thrombolysis In Cerebral Ischemia score 3) and had follow-up diffusion-weighted imaging (DWI) available were evaluated. Follow-up DWI lesions were coregistered to baseline CTP. The difference between baseline CTP core (relative cerebral blood flow [rCBF] <30%) volume and follow-up infarct volume was classified as overestimation (core ≥10 mL larger than infarct), adequate, or underestimation (core ≥25 mL smaller than infarct) and spatial overlap was evaluated.
RESULTS
Of 101 included patients, median time from last known well (LKW) to imaging acquisition was 138 (82-244) minutes. The median baseline ischemic core estimate was 9 (0-31.9) mL and median follow-up infarct volume was 18.4 (5.3-68.7) mL. All 6/101 (6%) patients with overestimation of the subsequent infarct volume were imaged within 90 minutes of LKW and achieved rapid reperfusion (within 120 minutes of CTP). Using rCBF <20% threshold to estimate ischemic core in patients presenting within 90 minutes eliminated overestimation. Volumetric correlation between the ischemic core estimate and follow-up imaging improved as LKW time to imaging acquisition increased: Spearman ρ <90 minutes 0.33 ( = 0.049), 90-270 minutes 0.63 ( < 0.0001), >270 minutes 0.86 ( < 0.0001). Assessment of the spatial overlap between baseline CTP ischemic core lesion and follow-up infarct demonstrated that a median of 3.2 (0.0-9.0) mL of estimated core fell outside the subsequent infarct. These regions were predominantly in white matter.
DISCUSSION
Significant overestimation of irreversibly injured ischemic core volume was rare, was only observed in patients who presented within 90 minutes of LKW and achieved reperfusion within 120 minutes of CTP acquisition, and occurred primarily in white matter. Use of a more conservative (rCBF <20%) threshold for estimating ischemic core in patients presenting within 90 minutes eliminated all significant overestimation cases.
TRIAL REGISTRATION INFORMATION
ClinicalTrials.gov: NCT03876457.
背景与目的
评估基线 CT 灌注（CTP）缺血核心估计的准确性。
方法
从 SELECT（急性缺血性脑卒中血管内治疗的影像选择优化）前瞻性多中心队列影像选择研究中，选取接受血管内血栓切除术且实现完全再灌注（改良脑梗死溶栓治疗评分 3 分）并具有随访弥散加权成像（DWI）的患者进行评估。将随访 DWI 病变与基线 CTP 配准。将基线 CTP 核心（相对脑血流量 [rCBF] <30%）体积与随访梗死体积之间的差异分类为高估（核心≥10mL 大于梗死）、适当或低估（核心≥25mL 小于梗死），并评估空间重叠情况。
结果
纳入的 101 例患者中，从最后一次明确状态（LKW）到影像采集的中位时间为 138（82-244）分钟。基线缺血核心估计中位数为 9（0-31.9）mL，随访梗死体积中位数为 18.4（5.3-68.7）mL。所有 6/101（6%）高估后续梗死体积的患者均在 LKW 后 90 分钟内成像，且实现快速再灌注（在 CTP 后 120 分钟内）。在发病 90 分钟内的患者中，使用 rCBF <20%的阈值来估计缺血核心可消除高估。随着 LKW 至影像采集时间的延长，缺血核心估计与随访影像之间的体积相关性增加：Spearman ρ<90 分钟 0.33（=0.049），90-270 分钟 0.63（<0.0001），>270 分钟 0.86（<0.0001）。对基线 CTP 缺血核心病变与随访梗死之间的空间重叠进行评估表明，中位 3.2（0.0-9.0）mL 的核心估计值落在后续梗死之外。这些区域主要位于白质。
讨论
严重高估不可逆损伤的缺血核心体积很少见，仅发生在 LKW 后 90 分钟内出现且 CTP 采集后 120 分钟内实现再灌注的患者中，主要发生在白质。在发病 90 分钟内的患者中，使用更保守的（rCBF <20%）阈值来估计缺血核心可消除所有显著高估的病例。
试验注册信息
ClinicalTrials.gov：NCT03876457。
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