Wu Rong-Rong, Cao Yue-Zhou, Xu Xiao-Quan, Jia Zheng-Yu, Zhao Lin-Bo, Shi Hai-Bin, Liu Sheng, Wu Fei-Yun, Lu Shan-Shan
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Gulou district, Nanjing, Jiangsu Province, China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Eur Radiol. 2023 Dec;33(12):9130-9138. doi: 10.1007/s00330-023-09965-7. Epub 2023 Jul 27.
To compare the prognostic value of net water uptake (NWU) and target mismatch (TM) on CT perfusion (CTP) in acute ischemic stroke (AIS) patients with late time window.
One hundred and nine consecutive AIS patients with anterior-circulation large vessel occlusion presenting within 6-24 h from onset/last seen well were enrolled. Automated Alberta Stroke Program Early CT Score-based NWU (ASPECTS-NWU) was calculated from admission CT. The correlation between ASPECTS-NWU and CTP parameters was assessed. Predictors for favorable outcome (modified Rankin Scale score ≤ 2) at 90 days were assessed using logistic regression analysis. The ability of outcome prediction between ASPECTS-NWU and TM (an ischemic core < 70 mL, a mismatch ratio ≥ 1.8, and an absolute difference ≥ 15 mL) was compared using receiver operating characteristic (ROC) curve.
A higher level of ASPECTS-NWU was associated with a larger ischemic core (r = 0.66, p < 0.001) and a larger hypoperfusion volume (r = 0.38, p < 0.001). ASPECTS-NWU performed better than TM for outcome stratification (area under the curve [AUC], 0.738 vs 0.583, p = 0.004) and was the only independent neuroimaging marker associated with favorable outcomes compared with CTP parameters (odds ratio, 0.73; 95% confidence interval [CI] 0.62-0.87, p < 0.001). An outcome prediction model including ASPECTS-NWU and clinical variables (National Institutes of Health Stroke Scale scores and age) yielded an AUC of 0.828 (95% CI 0.744-0.893; sensitivity 65.4%; specificity 87.7%).
ASPECTS-NWU performed better than TM for outcome prediction in AIS patients with late time window and might be an alternative imaging biomarker to CTP for patient selection.
Automated Alberta Stroke Program Early CT Score-based net water uptake outperforms target mismatch on CT perfusion for the outcome prediction in patients with acute ischemic stroke and can be an alternative imaging biomarker for patient selection in late therapeutic window.
• A higher ASPECTS-based net water uptake was associated with larger ischemic cores and hypoperfusion volumes on CT perfusion. • ASPECTS-based net water uptake outperformed target mismatch for outcome prediction in acute ischemic stroke with extended therapeutic window. • ASPECTS-based net water uptake can be an alternative biomarker to target mismatch for selecting acute ischemic stroke patients with late therapeutic window.
比较净吸水量（NWU）和目标不匹配（TM）对急性缺血性卒中（AIS）晚期时间窗患者CT灌注（CTP）的预后价值。
连续纳入109例发病/最后一次正常时间在6-24小时内出现前循环大血管闭塞的AIS患者。根据入院CT计算基于阿尔伯塔卒中项目早期CT评分的自动净吸水量（ASPECTS-NWU）。评估ASPECTS-NWU与CTP参数之间的相关性。采用逻辑回归分析评估90天时良好预后（改良Rankin量表评分≤2）的预测因素。使用受试者工作特征（ROC）曲线比较ASPECTS-NWU和TM（缺血核心<70 mL、不匹配率≥1.8且绝对差异≥15 mL）对预后预测的能力。
较高水平的ASPECTS-NWU与较大的缺血核心（r = 0.66，p < 0.001）和较大的低灌注体积（r = 0.38，p < 0.001）相关。在预后分层方面，ASPECTS-NWU的表现优于TM（曲线下面积[AUC]，0.738对0.583，p = 0.004），并且与CTP参数相比，是与良好预后相关的唯一独立神经影像标志物（比值比，0.73；95%置信区间[CI] 0.62-0.87，p < 0.001）。一个包含ASPECTS-NWU和临床变量（美国国立卫生研究院卒中量表评分和年龄）的预后预测模型的AUC为0.828（95%CI 0.744-0.893；敏感性65.4%；特异性87.7%）。
在晚期时间窗的AIS患者中，ASPECTS-NWU在预后预测方面的表现优于TM，可能是用于患者选择的替代CTP的影像生物标志物。
基于阿尔伯塔卒中项目早期CT评分的自动净吸水量在急性缺血性卒中患者的预后预测方面优于CT灌注上的目标不匹配，并且可以作为晚期治疗窗患者选择的替代影像生物标志物。
• 基于ASPECTS的较高净吸水量与CT灌注上较大的缺血核心和低灌注体积相关。• 在治疗窗延长的急性缺血性卒中中，基于ASPECTS的净吸水量在预后预测方面优于目标不匹配。• 基于ASPECTS的净吸水量可以作为选择晚期治疗窗急性缺血性卒中患者的替代目标不匹配的生物标志物。
