Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Interv Neuroradiol. 2024 Apr;30(2):189-194. doi: 10.1177/15910199221113900. Epub 2022 Jul 29.
Fluid-attenuated inversion recovery vascular hyperintensity (FVH) outside of the diffusion-weighted imaging (DWI) lesion, termed FVH-DWI mismatch, may represent penumbral tissue with good collateral status.
Consecutive patients who underwent endovascular reperfusion therapy (EVT) for acute internal carotid artery (ICA) or middle cerebral artery (MCA)-M1 occlusion were enrolled. FVH-DWI mismatch score was defined as the number of cortical Alberta Stroke Program Early CT Score areas (I and M1 to M6) that involved FVH but no DWI lesion (0 to 7 points). The outcome measure was set as good functional outcome, defined as a modified Rankin Scale score of 0 to 2, at 90 days after onset.
Of 196 consecutive patients who underwent EVT for acute ICA or MCA-M1 occlusion, 32 without brain MRI before EVT were excluded, and the remaining 164 were analyzed. The median FVH-DWI mismatch score was 2 (interquartile range, 0 to 4). At 90 days after EVT, 2 patients were lost-to follow-up, and 73 had good functional outcome. The frequency of good functional outcome at 90 days after EVT increased significantly with increasing FVH-DWI mismatch score (P for trend <0.001). FVH-DWI mismatch score was independently associated with good functional outcome at 90 days after onset (adjusted odds ratio per 1 point,1.46; 95% confidence interval, 1.15-1.89).
Patients with large FVH-DWI mismatch had good functional outcome after EVT for acute ICA or MCA-M1 occlusion.
弥散加权成像（DWI）病灶外的液体衰减反转恢复血管高信号（FVH），称为 FVH-DWI 不匹配，可能代表侧支循环良好的半暗带组织。
连续纳入接受血管内再灌注治疗（EVT）的急性颈内动脉（ICA）或大脑中动脉（MCA）M1 闭塞患者。FVH-DWI 不匹配评分定义为涉及 FVH 但无 DWI 病变的皮质 Alberta 卒中计划早期 CT 评分区域（I 和 M1 至 M6）的数量（0 至 7 分）。结局测量设定为发病后 90 天的良好功能结局，定义为改良 Rankin 量表评分 0 至 2 分。
在 196 例接受 EVT 治疗的急性 ICA 或 MCA-M1 闭塞患者中，32 例在 EVT 前未行脑部 MRI 检查，排除后，其余 164 例进行了分析。FVH-DWI 不匹配评分中位数为 2（四分位距，0 至 4）。在 EVT 后 90 天，2 例失访，73 例有良好的功能结局。FVH-DWI 不匹配评分与 EVT 后 90 天的良好功能结局呈显著正相关（趋势 P<0.001）。FVH-DWI 不匹配评分与发病后 90 天的良好功能结局独立相关（每增加 1 分的调整优势比，1.46；95%置信区间，1.15-1.89）。
急性 ICA 或 MCA-M1 闭塞患者 FVH-DWI 不匹配较大者 EVT 后功能结局良好。
