Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, P.R. China.
BMC Neurol. 2023 Oct 21;23(1):380. doi: 10.1186/s12883-023-03427-9.
Magnetic resonance imaging (MRI) and CT perfusion may provide diagnostic information for intravenous tissue-type plasminogen activator (IV t-PA) administration in acute ischemic stroke (AIS) patients. We aimed to compare the clinical features and perfusion deficits of diffusion weighted imaging (DWI)-negative and DWI-positive AIS patients.
This retrospective and observational study included thrombolysis-treated AIS patients undergoing multimodel CT imaging before treatment and DWI after treatment between 2021 and 2022. Two experienced neuroradiologists blindly and independently examined the images to identify perfusion deficits in AIS patients. The patients were divided into DWI-positive and DWI-negative groups based on visible hyperintense lesions on DWI. A modified Rankin scale (mRS) score of ≤ 2 indicated good functional outcomes at discharge. Sensitivity analysis was conducted to determine whether CT perfusion was an independent predictor of positive DWI imaging on follow-up.
This study included 151 patients, of whom 35 (23.2%) patients were DWI-negative on follow-up. These DWI-negative patients were less likely to have a medical history of atrial fibrillation; they had lower triglyceride levels, a shorter admission time, lower National Institutes of Health Stroke Scale (NIHSS) scores after IV t-PA and lower mRS scores at discharge, and had better functional outcomes. A total of 37.1% of DWI-positive and 25.7% of DWI-negative patients had vascular stenosis (P = 0.215). A total of 47.4% of DWI-positive and 37.1% of DWI-negative patients had CT perfusion deficits (P = 0.284). A total of 73.5% of patients with normal CT perfusion had positive DWI, while 19.1% of patients with perfusion deficits had negative DWI. The sensitivity and specificity of NCCT were 14.8% and 97.1% (Kappa = 0.061, P = 0.074), CTP was 47.4% and 62.9% for predicting DWI lesion (Kappa = 0.069, P = 0.284).
About 23.2% of AIS patients who received intravenous thrombolysis treatment did not have a relevant DWI-MRI lesion on follow-up. Over one-third of patients in the DWI-MRI negative group showed CT perfusion deficits, with a sensitivity of 47.4% for predicting DWI lesions in non-mechanical thrombectomy patients.
磁共振成像（MRI）和 CT 灌注成像可为接受静脉组织型纤溶酶原激活剂（IV t-PA）治疗的急性缺血性脑卒中（AIS）患者的治疗提供诊断信息。本研究旨在比较弥散加权成像（DWI）阴性和 DWI 阳性 AIS 患者的临床特征和灌注缺损情况。
本回顾性观察性研究纳入了 2021 年至 2022 年期间接受多模态 CT 成像检查且在治疗前接受 MRI 检查、治疗后接受 DWI 检查的溶栓治疗 AIS 患者。两名有经验的神经放射科医生对图像进行了盲法和独立检查，以确定 AIS 患者的灌注缺损情况。根据 DWI 上是否可见高信号病变，将患者分为 DWI 阳性和 DWI 阴性组。出院时改良 Rankin 量表（mRS）评分≤2 表示功能结局良好。敏感性分析用于确定 CT 灌注是否是随访时 DWI 阳性的独立预测因素。
本研究共纳入了 151 名患者，其中 35 名（23.2%）患者在随访时 DWI 结果为阴性。这些 DWI 阴性患者发生心房颤动的既往病史较少，其甘油三酯水平较低，入院时间较短，接受 IV t-PA 治疗后的美国国立卫生研究院卒中量表（NIHSS）评分较低，出院时的 mRS 评分较低，且功能结局更好。37.1%的 DWI 阳性患者和 25.7%的 DWI 阴性患者存在血管狭窄（P=0.215）。37.1%的 DWI 阳性患者和 47.4%的 DWI 阴性患者存在 CT 灌注缺损（P=0.284）。73.5%的 CT 灌注正常患者的 DWI 为阳性，而 19.1%的灌注缺损患者的 DWI 为阴性。NCCT 的敏感性和特异性分别为 14.8%和 97.1%（Kappa=0.061，P=0.074），CTP 的敏感性和特异性分别为 47.4%和 62.9%，用于预测 DWI 病变（Kappa=0.069，P=0.284）。
大约 23.2%接受静脉溶栓治疗的 AIS 患者在随访时 DWI 上未发现相关病变。DWI-MRI 阴性组中超过三分之一的患者存在 CT 灌注缺损，其预测非机械取栓患者 DWI 病变的敏感性为 47.4%。
