Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
Eur J Radiol. 2023 Jul;164:110861. doi: 10.1016/j.ejrad.2023.110861. Epub 2023 May 5.
To evaluate the feasibility of using iodine overlay maps reconstructed from dual-energy CT (DECT) to assess thrombus perviousness and investigate its value in predicting outcomes after intravenous thrombolysis in patients with acute ischemic stroke.
86 patients with proximal intracranial occlusions of the anterior circulation who underwent intravenous thrombolysis were included in this study. Thrombus iodine concentrations (IC) and normalized iodine concentrations (NIC) were compared to conventional perviousness parameters (thrombus attenuation increase, TAI; void fraction, ε and CTA-index). The associations between perviousness parameters and outcomes were analyzed by Spearman's correlation and regression analysis.
IC and NIC were significantly correlated with conventional perviousness parameters (P < 0.001). The median IC was 6.81 (interquartile range [IQR], 4.76-8.73) mg/ml in the favorable functional outcome group, which was higher than 3.52 (IQR, 2.08-6.86) mg/ml in the unfavorable outcome group (P = 0.001). The median NIC was 0.095 (IQR, 0.068-0.116) and 0.054 (IQR, 0.031-0.083) in the favorable and unfavorable outcome groups, respectively (P < 0.001). NIC predicted favorable outcome with a higher area under the curve (AUC) of 0.755 than any conventional perviousness parameter (P < 0.05). In the multivariable regression model, IC was independently associated with favorable outcome (odds ratio [OR] = 1.472, 95 % CI: 1.154-1.877, P = 0.002) and successful recanalization (OR = 1.356, 95 % CI: 1.093-1.681, P = 0.006). IC was negatively correlated with the final infarct volume (FIV) (r = -0.262, P = 0.020). Results for NIC were similar.
DECT is of great value in assessing thrombus perviousness. NIC is a meaningful predictor of stroke prognosis and recanalization after intravenous thrombolysis in acute ischemic stroke.
评估双能 CT（DECT）碘覆盖图重建用于评估血栓通透性的可行性，并探讨其在评估急性缺血性卒中患者静脉溶栓后结局的价值。
本研究纳入了 86 例接受静脉溶栓治疗的前循环近端颅内闭塞患者。比较了血栓碘浓度（IC）和归一化碘浓度（NIC）与常规通透性参数（血栓衰减增加、TAI；空分数、ε和 CTA 指数）。通过 Spearman 相关和回归分析来分析通透性参数与结局之间的相关性。
IC 和 NIC 与常规通透性参数呈显著相关（P<0.001）。在预后良好的功能结局组中，IC 的中位数为 6.81（四分位距[IQR]，4.76-8.73）mg/ml，高于预后不良结局组的 3.52（IQR，2.08-6.86）mg/ml（P=0.001）。在预后良好和预后不良结局组中，NIC 的中位数分别为 0.095（IQR，0.068-0.116）和 0.054（IQR，0.031-0.083）（P<0.001）。与任何常规通透性参数相比，NIC 预测良好结局的曲线下面积（AUC）更高（0.755 比 AUC 任何常规通透性参数均高，P<0.05）。在多变量回归模型中，IC 与良好结局（比值比[OR]，1.472；95%CI：1.154-1.877；P=0.002）和成功再通（OR，1.356；95%CI：1.093-1.681；P=0.006）独立相关。IC 与最终梗死体积（FIV）呈负相关（r=-0.262，P=0.020）。NIC 的结果类似。
DECT 在评估血栓通透性方面具有重要价值。NIC 是急性缺血性卒中患者静脉溶栓后预后和再通的有意义的预测指标。
