Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Eur Radiol. 2022 Oct;32(10):7026-7035. doi: 10.1007/s00330-022-09077-8. Epub 2022 Aug 18.
To investigate the value of automated Alberta Stroke Program Early CT Score (ASPECTS)-based net water uptake (NWU) to predict tissue-level reperfusion status and 90-day functional outcomes in acute ischemic stroke (AIS) patients after reperfusion therapy.
One hundred and twelve patients with AIS who received reperfusion therapy were enrolled. ASPECTS-NWU was calculated from admission CT (NWU) and follow-up CT (NWU), and the difference (ΔNWU) was calculated. Tissue-level reperfusion status was evaluated via follow-up arterial spin labeling imaging. The relationship between ASPECTS-NWU and tissue-level reperfusion was evaluated. Predictors of 90-day unfavorable outcomes (modified Rankin Scale score > 2) were assessed by multivariate logistic regression analysis and receiver operating characteristic (ROC) curves.
Poor reperfusion was observed in 40 patients (35.7%) after therapy. Those patients had significantly elevated NWU (median, 14.15% vs. 8.08%, p = 0.018) and higher ΔNWU (median, 4.12% vs. -2.03%, p < 0.001), compared to patients with good reperfusion. High ΔNWU was a significant marker of poor reperfusion despite successful recanalization. National Institutes of Health Stroke Scale score at admission (odds ratio [OR], 1.11; 95% confidence interval [CI] 1.03-1.20, p = 0.007) and ΔNWU (OR, 1.07; 95% CI 1.02-1.13, p = 0.008) were independently associated with unfavorable outcomes. An outcome prediction model including both parameters yields an area under the curve of 0.762 (sensitivity 70.3%, specificity, 84.2%).
Elevated NWU and higher ΔNWU were associated with poor tissue-level reperfusion after therapy. Higher ΔNWU was an independent predictor of poor reperfusion and unfavorable neurological outcomes despite successful recanalization.
• ASPECTS-NWU may provide pathophysiological information about tissue-level reperfusion status and offer prognostic benefits for patients with AIS after reperfusion therapy. • Elevated NWU and higher ΔNWU were correlated with poor tissue-level reperfusion after therapy. • A higher ΔNWU is an independent predictor of poor reperfusion and 90-day unfavorable outcomes despite successful recanalization.
探讨基于 Alberta 卒中计划早期 CT 评分（ASPECTS）的自动净水分摄取量（NWU）在急性缺血性卒中（AIS）患者再灌注治疗后预测组织水平再灌注状态和 90 天功能结局的价值。
纳入 112 例接受再灌注治疗的 AIS 患者。从入院 CT（NWU）和随访 CT（NWU）计算 ASPECTS-NWU，并计算差值（ΔNWU）。通过随访动脉自旋标记成像评估组织水平再灌注状态。评估 ASPECTS-NWU 与组织水平再灌注的关系。采用多变量逻辑回归分析和受试者工作特征（ROC）曲线评估 90 天不良结局（改良 Rankin 量表评分>2）的预测因素。
治疗后 40 例（35.7%）患者再灌注不良。与再灌注良好的患者相比，这些患者的 NWU（中位数，14.15% vs. 8.08%，p=0.018）和ΔNWU（中位数，4.12% vs. -2.03%，p<0.001）显著升高。尽管成功再通，但高ΔNWU 是再灌注不良的显著标志物。入院时国立卫生研究院卒中量表评分（比值比[OR]，1.11；95%置信区间[CI]，1.03-1.20，p=0.007）和ΔNWU（OR，1.07；95%CI，1.02-1.13，p=0.008）与不良结局独立相关。包括这两个参数的预测模型的曲线下面积为 0.762（灵敏度 70.3%，特异性 84.2%）。
升高的 NWU 和更高的ΔNWU 与治疗后组织水平再灌注不良相关。更高的ΔNWU 是成功再通后再灌注不良和不良神经结局的独立预测因子。
• ASPECTS-NWU 可能为接受再灌注治疗的 AIS 患者提供有关组织水平再灌注状态的病理生理学信息，并提供预后益处。• 升高的 NWU 和更高的ΔNWU 与治疗后组织水平再灌注不良相关。• 即使成功再通，更高的ΔNWU 也是再灌注不良和 90 天不良结局的独立预测因子。
