School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Radiology Department, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
J Magn Reson Imaging. 2023 Sep;58(3):838-847. doi: 10.1002/jmri.28596. Epub 2023 Jan 10.
Neurometabolite concentrations provide a direct index of infarction progression in stroke. However, their relationship with stroke onset time remains unclear.
To assess the temporal dynamics of N-acetylaspartate (NAA), creatine, choline, and lactate and estimate their value in predicting early (<6 hours) vs. late (6-24 hours) hyperacute stroke groups.
Cross-sectional cohort.
A total of 73 ischemic stroke patients scanned at 1.8-302.5 hours after symptom onset, including 25 patients with follow-up scans.
FIELD STRENGTH/SEQUENCE: A 3 T/magnetization-prepared rapid acquisition gradient echo sequence for anatomical imaging, diffusion-weighted imaging and fluid-attenuated inversion recovery imaging for lesion delineation, and 3D MR spectroscopic imaging (MRSI) for neurometabolic mapping.
Patients were divided into hyperacute (0-24 hours), acute (24 hours to 1 week), and subacute (1-2 weeks) groups, and into early (<6 hours) and late (6-24 hours) hyperacute groups. Bayesian logistic regression was used to compare classification performance between early and late hyperacute groups by using different combinations of neurometabolites as inputs.
Linear mixed effects modeling was applied for group-wise comparisons between NAA, creatine, choline, and lactate. Pearson's correlation analysis was used for neurometabolites vs. time. P < 0.05 was considered statistically significant.
Lesional NAA and creatine were significantly lower in subacute than in acute stroke. The main effects of time were shown on NAA (F = 14.321) and creatine (F = 12.261). NAA was significantly lower in late than early hyperacute patients, and was inversely related to time from symptom onset across both groups (r = -0.440). The decrease of NAA and increase of lactate were correlated with lesion volume (NAA: r = -0.472; lactate: r = 0.366) in hyperacute stroke. Discrimination was improved by combining NAA, creatine, and choline signals (area under the curve [AUC] = 0.90).
High-resolution 3D MRSI effectively assessed the neurometabolite changes and discriminated early and late hyperacute stroke lesions.
Stage 2.
神经代谢物浓度为梗死进展提供了直接的指标，而其与卒中发病时间的关系仍不清楚。
评估 N-乙酰天门冬氨酸（NAA）、肌酸、胆碱和乳酸的时间动态变化，并评估其对超急性期（＜6 小时）与急性期（6-24 小时）卒中组的预测价值。
横断面队列研究。
73 例缺血性卒中患者，在症状发作后 1.8-302.5 小时进行扫描，其中 25 例有随访扫描。
场强/序列：3T/magnetization-prepared rapid acquisition gradient echo 序列用于解剖成像，扩散加权成像和液体衰减反转恢复成像用于病灶勾画，3D 磁共振波谱成像（MRSI）用于神经代谢成像。
将患者分为超急性期（0-24 小时）、急性期（24 小时至 1 周）和亚急性期（1-2 周），并分为早期（＜6 小时）和晚期（6-24 小时）超急性期。采用贝叶斯逻辑回归，比较不同神经代谢物组合作为输入时早期和晚期超急性期之间的分类性能。
线性混合效应模型用于 NAA、肌酸、胆碱和乳酸的组间比较。Pearson 相关分析用于神经代谢物与时间的相关性分析。P＜0.05 被认为具有统计学意义。
亚急性期卒中患者病灶区 NAA 和肌酸明显低于急性期卒中患者。时间的主要效应显示在 NAA（F=14.321）和肌酸（F=12.261）上。晚期超急性期患者 NAA 明显低于早期，两组之间 NAA 与发病时间呈负相关（r=-0.440）。超急性期卒中时，NAA 降低和乳酸升高与病灶体积相关（NAA：r=-0.472；乳酸：r=0.366）。结合 NAA、肌酸和胆碱信号可提高鉴别能力（曲线下面积[AUC]为 0.90）。
高分辨率 3D MRSI 能有效评估神经代谢物的变化，并能区分早期和晚期超急性期卒中病灶。
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2 级。
