From the Paris Brain Institute (Institut du Cerveau-ICM), Center for Neuroimaging Research-CENIR, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, CS 21414, 75646 Paris Cedex 13, France (G.G., L.Y.C., S.L., F.B.); Hopital Pitié-Salpêtrière, ICM, Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Paris, France (G.G., F.X.L., L.Y.C., S.L., F.B., C.R.); APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France (B.D.F., C.R.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (G.G., M.M.); Paris Brain Institute's Data Analysis Core, Paris, France (F.X.L.); Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, United Kingdom (I.R.); and STARE Team, iCRIN, Institut du Cerveau et de la Moelle Épinière, ICM, Paris, France (C.R.).
Radiology. 2023 Mar;306(3):e220430. doi: 10.1148/radiol.220430. Epub 2022 Nov 1.
Background The time course of cellular damage after acute ischemic stroke (IS) is currently not well known, and specific noninvasive markers of microstructural alterations linked to inflammation are lacking, which hinders the monitoring of anti-inflammatory treatment. Purpose To evaluate the temporal pattern of neuronal and glial microstructural changes after stroke using in vivo single-voxel diffusion-weighted MR spectroscopy. Materials and Methods In this prospective longitudinal study, participants with IS and healthy volunteers (HVs) underwent MRI at 3.0 T. In participants with IS, apparent diffusion coefficients (ADCs) and concentrations of total -acetyl-aspartate (tNAA), total creatine (tCr), and total choline (tCho) were measured in volumes of interest (VOIs), including the lesion VOI (VOI) and the contralateral VOI (VOI) at 2 weeks, 1 month, and 3 months after IS. HVs were examined once, with VOIs located in the same brain regions as participants with IS. Within- and between-group differences and longitudinal changes were examined using linear mixed-effects models. Results Twenty participants with IS (mean age, 61 years ± 13 [SD]; 12 women) and 20 HVs (mean age, 59 years ± 13; 12 women) were evaluated. No differences in ADCs or concentrations were observed in VOI between HVs and participants with IS. In participants with IS, the ADC of tCr was higher in VOI than in VOI at 1 month (+14.4%, = .004) and 3 months after IS (+19.0%, < .001), while the ADC of tCho was higher only at 1 month (+16.7%, = .001). No difference in the ADC of tNAA was observed between the two VOIs at any time point. tNAA and tCr concentrations were lower in VOI than in VOI and were stable over time (approximately -50% and -30%, respectively; < .001). Conclusion High diffusivity of choline-containing compounds and total creatine (tCr) in the ischemic lesion 1 month after ischemic stroke (IS) indicates glial morphologic changes, suggesting that active inflammation is still ongoing at this time point. High tCr diffusivity up to 3 months after IS likely reflects the presence of astrogliosis at the chronic stage of cerebral ischemia. Clinical trial registration no. NCT02833961 © RSNA, 2022 .
背景 目前，人们对于急性缺血性脑卒中（IS）后细胞损伤的时间进程尚不清楚，且缺乏与炎症相关的特定微观结构改变的非侵入性标志物，这阻碍了对抗炎治疗的监测。目的 利用活体单体素扩散加权磁共振波谱评估脑卒中后神经元和神经胶质的微观结构变化的时间模式。材料与方法 本前瞻性纵向研究纳入了 IS 患者和健康志愿者（HV），并在 3.0T 磁共振仪上进行检查。在 IS 患者中，在脑卒中后 2 周、1 个月和 3 个月，通过在感兴趣容积（VOI）中测量表观扩散系数（ADC）和总 -N- 乙酰天冬氨酸（tNAA）、总肌酸（tCr）和总胆碱（tCho）浓度，来评估病变 VOI（VOI）和对侧 VOI（VOI）。HV 仅接受一次检查，VOI 位于与 IS 患者相同的脑区。使用线性混合效应模型来评估组内和组间差异以及纵向变化。结果 共纳入 20 例 IS 患者（平均年龄，61 岁±13[标准差]；12 例女性）和 20 例 HV。HV 和 IS 患者的 VOI 之间的 ADC 或浓度无差异。在 IS 患者中，与 VOI 相比，1 个月（+14.4%， =.004）和 3 个月（+19.0%， <.001）时，VOI 中的 tCr ADC 更高，而 tCho ADC 仅在 1 个月时更高（+16.7%， =.001）。在任何时间点，两个 VOI 之间的 tNAA ADC 均无差异。VOI 中的 tNAA 和 tCr 浓度均低于 VOI，且随时间保持稳定（分别约为-50%和-30%； <.001）。结论 脑卒中后 1 个月时，缺血病变中胆碱化合物和总肌酸（tCr）的高弥散性提示胶质形态发生变化，表明此时炎症仍在活跃进行。脑卒中后 3 个月时 tCr 高弥散性可能反映了脑缺血慢性期的星形胶质增生。临床试验注册号 NCT02833961 © RSNA，2022
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