癫痫持续状态与急性缺血性卒中鉴别诊断中扩散受限病变的定量分析
Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke.
作者信息
Machegger Lukas, Bosque Varela Pilar, Kuchukhidze Giorgi, Steinbacher Jürgen, Öllerer Andreas, Prüwasser Tanja, Zimmermann Georg, Pikija Slaven, Pfaff Johannes, Trinka Eugen, Mc Coy Mark
机构信息
Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria.
出版信息
Front Neurol. 2022 Jul 7;13:926381. doi: 10.3389/fneur.2022.926381. eCollection 2022.
BACKGROUND AND PURPOSE
Distinction between acute ischemic stroke (AIS) and status epilepticus (SE) on MRI can be challenging as restricted diffusion may occur in both conditions. In this study, we aimed to test a tool, which could help in differentiating AIS from SE when restricted diffusion was present on MRI.
MATERIALS AND METHODS
In diffusion weighted imaging (DWI) with a b-value of 1,000 and apparent diffusion coefficient (ADC) maps, we compared the ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side in patients with AIS and SE. Patients were recruited prospectively between February 2019 and October 2021. All patients underwent MRI and EEG within the first 48 h of symptom onset.
RESULTS
We identified 26 patients with SE and 164 patients with AIS. All patients had diffusion-restricted lesions with a hyperintensity in DWI and ADC signal decrease. Diffusion restriction was significantly more intense in patients with AIS as compared to patients with SE. The median ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side for DWI were 1.42 (interquartile range [IQR] 1.32-1.47) in SE and 1.67 (IQR 1.49-1.90) in AIS ( < 0.001). ADC decrease was more significant in AIS as compared to SE with median ratios of 0.80 (IQR 0.72-0.89) vs. 0.61 (IQR 0.50-0.71), respectively ( < 0.001). A cutoff value for ratios of DWI signal was 1.495 with a sensitivity of 75% and a specificity of 85%. Values lower than 1.495 were more likely to be associated with SE and higher values were with AIS. A cutoff value for ADC ratios was 0.735 with a sensitivity of 73% and a specificity of 84%. Values lower than 0.735 were more likely to be associated with AIS and higher values were with SE.
CONCLUSION
Diffusion restriction and ADC decrease were significantly more intense in patients with AIS as compared to SE. Therefore, quantitative analysis of diffusion restriction may be a helpful tool for differentiating between AIS and SE when restricted diffusion is present on MRI.
背景与目的
在磁共振成像（MRI）上区分急性缺血性卒中（AIS）和癫痫持续状态（SE）具有挑战性，因为在这两种情况下都可能出现扩散受限。在本研究中，我们旨在测试一种工具，当MRI上出现扩散受限时，该工具可有助于区分AIS和SE。
材料与方法
在b值为1000的扩散加权成像（DWI）和表观扩散系数（ADC）图中，我们比较了AIS和SE患者中扩散受限病变的灰度值强度与健康对侧的比率。在2019年2月至2021年10月期间前瞻性招募患者。所有患者在症状发作的前48小时内接受了MRI和脑电图检查。
结果
我们确定了26例SE患者和164例AIS患者。所有患者均有扩散受限病变，DWI呈高信号且ADC信号降低。与SE患者相比，AIS患者的扩散受限明显更严重。SE患者DWI上扩散受限病变的灰度值强度与健康对侧的中位数比率为1.42（四分位间距[IQR]1.32 - 1.47），AIS患者为1.67（IQR 1.49 - 1.90）（<0.001）。与SE相比，AIS患者的ADC降低更显著，中位数比率分别为0.80（IQR 0.72 - 0.89）和0.61（IQR 0.50 - 0.71）（<0.001）。DWI信号比率的截断值为1.495，敏感性为75%，特异性为85%。低于1.495的值更可能与SE相关，而较高的值与AIS相关。ADC比率的截断值为0.735，敏感性为73%，特异性为84%。低于0.735的值更可能与AIS相关，而较高的值与SE相关。
结论
与SE患者相比，AIS患者的扩散受限和ADC降低明显更严重。因此，当MRI上出现扩散受限时，对扩散受限进行定量分析可能是区分AIS和SE的有用工具。
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