使用新型自动灌注加权成像软件评估急性缺血性卒中的弥散灌注不匹配：一项回顾性研究

Evaluation of Diffusion-Perfusion Mismatch in Acute Ischemic Stroke with a New Automated Perfusion-Weighted Imaging Software: A Retrospective Study.

作者信息

Xiong Yunyun, Luo Yu, Wang Mingming, Yang Shih-Ting, Shi Ruiqiong, Ye Wanxing, Li Guangshuo, Yang Kaixuan, Wang Shang, Li Zixiao, Wang Yongjun

机构信息

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

China National Clinical Research Center for Neurological Diseases, Beijing, China.

出版信息

Neurol Ther. 2022 Dec;11(4):1777-1788. doi: 10.1007/s40120-022-00409-w. Epub 2022 Oct 6.

DOI:10.1007/s40120-022-00409-w

PMID:36201112

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9588132/

Abstract

INTRODUCTION

The aim of this study was to evaluate the accuracy of automated software (iStroke) on magnetic resonance (MR) apparent diffusion coefficient (ADC) and perfusion-weighted imaging (PWI) against ground truth in assessing infarct core, and compare the hypoperfusion volume and mismatch volume on iStroke with those on Food and Drug Administration-approved software (RAPID) in patients with acute ischemic stroke.

METHODS

We used the single-volume decomposition method to develop the iStroke (iStroke; Beijing Tiantan Hospital, Beijing, China) software. Patients with ischemic stroke were collected from two educational hospitals in China with MR-PWI performed in the emergency department within 24 h of symptom onset. Infarct core volume was defined as ADC < 620 × 10 mm/s and hypoperfusion volume was defined as Tmax > 6 s. We compared the accuracy of infarct core volume using iStroke and RAPID (iSchema View Inc, Menlo Park, CA) software with ground truth.

RESULTS

We included 405 patients with acute ischemic stroke with MR ADC and PWI sequences. The infarct core volume on iStroke (median 2.43 ml, interquartile range [IQR] 0.60-10.32 ml) was not significantly different from the ground truth (median 2.89 ml, IQR 0.77-9.17 ml) (P = 0.07); Bland-Altman curves showed that the core volume of iStroke and RAPID software were comparable with each other on individual agreement with ground truth. The hypoperfusion volume and mismatch volume on iStroke were not statistically different from those on the RAPID software, respectively. In patients with large vessel occlusion (n = 74), the agreement between iStroke and RAPID was substantial (kappa = 0.76) according to DEFUSE 3 criteria (infarct core < 70 ml, mismatch volume ≥ 15 ml, and mismatch ratio ≥ 1.8).

CONCLUSIONS

The iStroke automatic processing of ADC and PWI is a reliable software for the identification of diffusion-perfusion mismatch in acute ischemic stroke.

摘要

引言

本研究旨在评估自动化软件（iStroke）在磁共振（MR）表观扩散系数（ADC）和灌注加权成像（PWI）方面相对于真实情况评估梗死核心的准确性，并比较急性缺血性卒中患者中iStroke与美国食品药品监督管理局批准的软件（RAPID）的低灌注体积和不匹配体积。

方法

我们使用单体积分解方法开发了iStroke（iStroke；中国北京天坛医院）软件。从中国的两家教学医院收集缺血性卒中患者，在症状发作后24小时内在急诊科进行MR-PWI检查。梗死核心体积定义为ADC＜620×10⁻⁶mm²/s，低灌注体积定义为Tmax＞6秒。我们比较了使用iStroke和RAPID（iSchema View Inc，加利福尼亚州门洛帕克）软件测量梗死核心体积与真实情况的准确性。

结果

我们纳入了405例有MR ADC和PWI序列的急性缺血性卒中患者。iStroke测量的梗死核心体积（中位数2.43ml，四分位数间距[IQR]0.60 - 10.32ml）与真实情况（中位数2.89ml，IQR 0.77 - 9.17ml）无显著差异（P = 0.07）；Bland-Altman曲线显示，iStroke和RAPID软件的核心体积在与真实情况的个体一致性方面彼此相当。iStroke的低灌注体积和不匹配体积与RAPID软件的相应体积在统计学上无差异。在大血管闭塞患者（n = 74）中，根据DEFUSE 3标准（梗死核心＜70ml，不匹配体积≥15ml，不匹配率≥1.8），iStroke与RAPID之间的一致性较高（kappa = 0.76）。