Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Departments of Clinical Neuroscience and Radiology, Cummings School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Transl Stroke Res. 2023 Aug;14(4):562-571. doi: 10.1007/s12975-022-01058-9. Epub 2022 Jul 1.
Computed tomography perfusion (CTP) is used as a tool to select ischemic stroke patients for endovascular treatment (EVT) and is currently investigated in the setting of extensive stroke with low Alberta Stroke Program Early CT scores (ASPECTS). The purpose of this study was to perform a comprehensive quantitative analysis of cerebral blood flow within the ischemic lesion compared to threshold-derived core lesion volumes. We hypothesized that the degree of cerebral blood volume (CBV) reduction within the ischemic lesion is predictive of irreversible tissue injury and functional outcome in patients with low ASPECTS. Ischemic stroke patients with an ASPECTS ≤ 5 who received multimodal CT on admission and underwent thrombectomy were analyzed. The ischemic lesion on CTP was identified, and CTP-derived parameters were measured as absolute means within the lesion and relative to the physiological perfusion measured in a contralateral region of interest. The degree of irreversible tissue injury was assessed using quantitative net water uptake (NWU). Functional endpoint was good outcome defined as modified Rankin Scale (mRS) scores 0-3 at day 90. One hundred eleven patients were included. The median core lesion volume was 71 ml (IQR: 25-107), and the median quantitative NWU was 9.5% (IQR: 6-13). Relative CBV (rCBV) reduction and ASPECTS at baseline were independently associated with NWU in multivariable linear regression analysis (ß: 12.4, 95%CI: 6.0-18.9, p < 0.0001) and (ß: - 0.78, 95% CI: - 1.53 to - 0.02; p = 0.045), respectively. Furthermore, rCBV was significantly associated with good outcome in patients with core volumes > 50 ml (OR: 0.16, 95% CI: 0.05-0.49, p = 0.001). Our study shows that rCBV reduction serves as an early surrogate for increase of NWU as a marker of irreversible tissue injury and lesion progression. Thus, the analysis of rCBV reduction within ischemic lesions may add another dimension to acute stroke triage in addition to core volumes or ASPECTS as indicators of the infarct extent and viability.
计算机断层灌注 (CTP) 被用作选择血管内治疗 (EVT) 的缺血性卒中患者的工具，目前正在广泛的低 Alberta 卒中项目早期 CT 评分 (ASPECTS) 卒中患者中进行研究。本研究的目的是对缺血性病变内的脑血流进行全面的定量分析，并与基于阈值的核心病变体积进行比较。我们假设，缺血性病变内脑血容量 (CBV) 减少的程度可预测低 ASPECTS 患者的不可逆转的组织损伤和功能结局。对入院时接受多模态 CT 检查并接受血栓切除术的 ASPECTS≤5 的缺血性卒中患者进行了分析。在 CTP 上识别出缺血性病变，并测量 CTP 衍生参数作为病变内的绝对值和与对侧感兴趣区测量的生理灌注的相对值。使用定量净水分摄取 (NWU) 评估不可逆性组织损伤的程度。功能终点为 90 天改良 Rankin 量表 (mRS) 评分 0-3 的良好结局。共纳入 111 例患者。核心病变体积中位数为 71ml（IQR：25-107），定量 NWU 中位数为 9.5%（IQR：6-13）。多变量线性回归分析显示，基线时相对 CBV (rCBV) 减少和 ASPECTS 与 NWU 独立相关（β：12.4，95%CI：6.0-18.9，p<0.0001）和（β：-0.78，95%CI：-1.53 至-0.02；p=0.045）。此外，rCBV 与核心体积>50ml 患者的良好结局显著相关（OR：0.16，95%CI：0.05-0.49，p=0.001）。本研究表明，rCBV 减少可作为 NWU 增加的早期替代标志物，作为不可逆转的组织损伤和病变进展的标志物。因此，除了核心体积或 ASPECTS 作为梗死范围和存活的指标外，分析缺血性病变内 rCBV 减少可能为急性卒中分诊增加另一个维度。
