Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan.
Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Musashino, Tokyo, Japan.
Clin Neuroradiol. 2023 Dec;33(4):965-971. doi: 10.1007/s00062-023-01295-x. Epub 2023 Jun 6.
The overall goal of our study is to create modified Alberta Stroke Program Early Computed Tomography Score (ASPECTS) determined by the findings on arterial spin labeling imaging (ASL) to predict the prognosis of patients with acute ischemic stroke after successful mechanical thrombectomy (MT). Prior to that, we examined predictive factors including the value of cerebral blood flow (CBF) measured by ASL for occurrence of cerebral infarction at the region of interest (ROI) used in the ASPECTS after successful MT.
Of the 92 consecutive patients with acute ischemic stroke treated with MT at our institution between April 2013 and April 2021, a total of 26 patients who arrived within 8 h after stroke onset and underwent MT resulting in a thrombolysis in cerebral infarction score of 2B or 3 were analyzed. Magnetic resonance imaging, including diffusion-weighted imaging (DWI) and ASL, was performed on arrival and the day after MT. The asymmetry index (AI) of CBF by ASL (ASL-CBF) before MT was calculated for 11 regions of interest using the DWI-Alberta Stroke Program Early CT Score.
Occurrence of infarction after successful MT for ischemic stroke in the anterior circulation can be expected when the formula 0.3211 × history of atrial fibrillation +0.0096 × the AI of ASL-CBF before MT (%) +0.0012 × the time from onset to reperfusion (min) yields a value below 1.0 or when the AI of ASL-CBF before MT is below 61.5%.
The AI of ASL-CBF before MT or a combination of a history of atrial fibrillation, the AI of ASL-CBF before MT, and the time from onset to reperfusion can be used to predict the occurrence of infarction in patients arriving within 8 h after stroke onset in which reperfusion with MT was successful.
本研究的总体目标是通过动脉自旋标记成像（ASL）的发现，创建改良的 Alberta 卒中项目早期计算机断层扫描评分（ASPECTS），以预测机械血栓切除术（MT）成功后急性缺血性卒中患者的预后。在此之前，我们检查了包括 ASL 测量的脑血流量（CBF）在内的预测因素，以预测成功 MT 后 ASPECTS 中感兴趣区域（ROI）发生脑梗死的情况。
在 2013 年 4 月至 2021 年 4 月期间，我院对 92 例连续接受 MT 治疗的急性缺血性卒中患者进行了回顾性分析，其中 26 例患者在卒中发作后 8 小时内到达并接受 MT，结果血栓溶解评分达到 2B 或 3。入院后和 MT 后第 1 天进行磁共振成像，包括弥散加权成像（DWI）和 ASL。在 MT 前使用 DWI-Alberta 卒中项目早期 CT 评分计算 11 个 ROI 的 ASL（ASL-CBF）的不对称指数（AI）。
在前循环缺血性卒中 MT 成功后，当公式 0.3211×房颤病史+0.0096×MT 前 ASL-CBF 的 AI（%）+0.0012×发病至再灌注时间（min）的乘积值低于 1.0 或 MT 前 ASL-CBF 的 AI 低于 61.5%时，预计会发生梗塞。
MT 前 ASL-CBF 的 AI 或房颤病史、MT 前 ASL-CBF 的 AI 与发病至再灌注时间的组合可用于预测在卒中发病后 8 小时内到达并接受 MT 再灌注成功的患者发生梗塞的情况。
