Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands.
Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands.
Neuroimage Clin. 2023;37:103340. doi: 10.1016/j.nicl.2023.103340. Epub 2023 Jan 31.
Restoring blood flow to brain tissue at risk of infarction is essential for tissue survival and clinical outcome. We used cerebral blood flow (CBF) quantified with multiple post-labeling delay (PLD) pseudocontinuous arterial spin labeling (ASL) MRI after ischemic stroke and assessed the association between CBF and early neurological outcome. We acquired ASL with 7 PLDs at 3.0 T in large vessel occlusion stroke patients at 24 h. We quantified CBF relative to the contralateral hemisphere (rCBF) and defined hyperperfusion as a ≥30% increase and hypoperfusion as a ≥40% decrease in rCBF. We included 44 patients (median age: 70 years, median NIHSS: 13, 40 treated with endovascular thrombectomy) of whom 37 were recanalized. Hyperperfusion in ischemic core occurred in recanalized but not in non-recanalized patients (65.8% vs 0%, p = 0.006). Hypoperfusion occurred only in the latter group (0% vs 85.7%, p < 0.001). In recanalized patients, hyperperfusion was also seen in salvaged penumbra (38.9%). Higher rCBF in ischemic core (aβ, -2.75 [95% CI: -4.11 to -1.40]) and salvaged penumbra (aβ, -5.62 [95% CI: -9.57 to -1.68]) was associated with lower NIHSS scores at 24 h. In conclusion, hyperperfusion frequently occurs in infarcted and salvaged brain tissue following successful recanalization and early neurological outcome is positively associated with the level of reperfusion.
恢复有梗塞风险的脑组织血流对于组织存活和临床转归至关重要。我们在缺血性卒中后使用多标记延迟（PLD）假性连续动脉自旋标记（ASL）MRI 量化脑血流（CBF），并评估 CBF 与早期神经功能结局之间的相关性。我们在 24 小时内对大血管闭塞性卒中患者在 3.0 T 上使用 7 个 PLD 采集 ASL，相对对侧半球（rCBF）量化 CBF，并将高灌注定义为 rCBF 增加≥30%，低灌注定义为 rCBF 减少≥40%。我们纳入了 44 名患者（中位数年龄：70 岁，中位数 NIHSS：13，40 名接受血管内血栓切除术治疗），其中 37 名患者再通。再通患者的缺血核心区出现高灌注（65.8% vs 0%，p = 0.006），而非再通患者未出现高灌注（0% vs 85.7%，p < 0.001）。仅在后一组中观察到低灌注（0% vs 85.7%，p < 0.001）。在再通患者中， salvaged penumbra 也出现了高灌注（38.9%）。缺血核心（aβ，-2.75 [95%CI：-4.11 至-1.40]）和 salvaged penumbra（aβ，-5.62 [95%CI：-9.57 至-1.68]）的 rCBF 越高，24 小时时 NIHSS 评分越低。总之，在成功再通后，梗死和 salvaged 脑组织中经常出现高灌注，早期神经功能结局与再灌注水平呈正相关。
