Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Clin Radiol. 2022 Aug;77(8):570-576. doi: 10.1016/j.crad.2022.04.003. Epub 2022 May 18.
To evaluate the prognostic value of the hypoperfusion intensity ratio (HIR) on 90-day clinical outcome in acute ischaemic stroke (AIS) patients with late therapeutic window.
One hundred and sixty-eight consecutive AIS patients with anterior-circulation large-vessel occlusion who underwent endovascular thrombectomy during the late window were enrolled retrospectively. Clinical data, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) based on unenhanced computed tomography (CT), and perfusion parameters included ischaemic core, hypoperfusion volume, mismatch volume between core and penumbra, and the HIR were assessed and compared between patients with or without favourable outcomes (defined as modified Rankin Scale score of 0-2). Statistical analysis included binary logistic regression and receiver operating characteristic (ROC) analyses.
A favourable outcome was achieved in 76 (45.2%) patients. In univariable analysis, age, National Institutes of Health Stroke Scale (NIHSS) score at admission, ASPECTS score, HIR, ischaemic core, and hypoperfusion volume were significantly associated with functional outcome (p<0.05). In multivariate analyses, age (OR 0.95; 95% CI 0.92-0.99), NIHSS score at admission (OR 0.89, 95% CI 0.84-0.96) and HIR (OR 0.018, 95% CI 0.003-0.113) remained as independent outcome predictors (p<0.01). The optimal threshold of HIR was 0.36 (sensitivity 70.7%, specificity 61.8%). The combination of age, NIHSS score at admission, and HIR yield good performance for outcome prediction with an area under the ROC curve of 0.815 (sensitivity 88.2%, specificity 64.1%), significantly higher than individual variable (p<0.05).
Low HIR was a predictor for favourable outcome in AIS patients with late therapeutic window. Integrating HIR with clinical variables improved the ability for outcome classification.
评估低灌注强度比（HIR）对急性缺血性脑卒中（AIS）患者治疗窗口期后 90 天临床预后的预测价值。
回顾性纳入 168 例接受血管内血栓切除术治疗的前循环大血管闭塞性 AIS 患者。评估和比较了患者的临床数据、基于未增强 CT 的 Alberta 卒中项目早期 CT 评分（ASPECTS）以及灌注参数，包括缺血核心、低灌注体积、核心与半暗带之间的不匹配体积和 HIR。根据改良 Rankin 量表评分（mRS）将患者分为预后良好组（0-2 分）和预后不良组（mRS 评分 3-6 分）。统计分析包括二元逻辑回归和受试者工作特征（ROC）分析。
76 例（45.2%）患者预后良好。单因素分析显示，年龄、入院时 NIHSS 评分、ASPECTS 评分、HIR、缺血核心和低灌注体积与功能结局显著相关（p<0.05）。多因素分析显示，年龄（OR 0.95；95%CI 0.92-0.99）、入院时 NIHSS 评分（OR 0.89，95%CI 0.84-0.96）和 HIR（OR 0.018，95%CI 0.003-0.113）是独立的预后预测因素（p<0.01）。HIR 的最佳阈值为 0.36（敏感度 70.7%，特异度 61.8%）。年龄、入院时 NIHSS 评分和 HIR 的联合应用对预后预测具有良好的性能，ROC 曲线下面积为 0.815（敏感度 88.2%，特异度 64.1%），显著高于单一变量（p<0.05）。
低 HIR 是 AIS 患者治疗窗口期后预后良好的预测因素。HIR 与临床变量相结合可提高预后分类能力。
