扩散加权成像阴性的缺血性卒中的预后与分布：一项系统评价和Meta分析

Prognosis and distribution of ischemic stroke with negative diffusion-weighted imaging: a systematic review and meta-analysis.

作者信息

Alkhiri Ahmed, Alturki Fahad, Alansari Nayef M, Almaghrabi Ahmed A, Alghamdi Basil A, Alamri Aser F, Alghamdi Saeed, Makkawi Seraj

机构信息

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.

King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.

出版信息

Front Neurol. 2024 Apr 26;15:1376439. doi: 10.3389/fneur.2024.1376439. eCollection 2024.

DOI:10.3389/fneur.2024.1376439

PMID:38737347

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11082379/

Abstract

BACKGROUND

Magnetic resonance diffusion-weighted imaging (DWI) is the most sensitive modality for ischemic stroke diagnosis. However, DWI may fail to detect ischemic lesions in a proportion of patients.

METHODS

Following PRISMA statement, a systematic search of Medline, Embase, and Web of Science was conducted until January 3, 2024. The inclusion was confined to English literature with sufficient reporting. Proportions of DWI-negative ischemic stroke were pooled. For binary variables, odds ratios (ORs) were computed using the random-effects model.

RESULTS

Fourteen studies constituting 16,268 patients with a clinical diagnosis of ischemic stroke and available DWI findings were included. Intravenous thrombolysis (IVT) was administered to 19.6% of the DWI-negative group and 15.3% of the DWI-positive group. DWI-negative ischemic stroke was reported in 16% (95% CI: 10-24%; after sensitivity analysis: 11% [95% CI: 8-15%]) of stroke patients. Among minor stroke patients (National Institutes of Health Stroke scale [NIHSS] of 5 or less), 24% (95% CI 12-42%) had negative DWI findings. Predictors of DWI-negative scans included posterior circulation stroke, history of ischemic heart disease, prior stroke, or prior transient ischemic attack. Cardioembolic stroke (OR, 0.62, 95% CI: 0.41-0.93) and history of atrial fibrillation increased the likelihood of positive DWI findings (OR, 0.56, 95% CI: 0.45-0.71). Patients with DWI-negative ischemic stroke had higher odds of good functional outcomes (modified Rankin scale [mRS] of 0-1) (OR, 2.26; 95% CI: 1.03-4.92), lower odds of stroke recurrence (OR, 0.68; 95% CI: 0.48-0.96), and lower odds of severe disability or mortality (mRS of 3-6) (OR, 0.44; 95% CI: 0.34-0.57) compared to patients with positive DWI. Rates of symptomatic intracerebral hemorrhage after IVT were comparable between groups.

CONCLUSION

DWI-negative findings were present in a significant proportion of ischemic stroke patients and may be utilized as a marker for favorable prognosis.

摘要

背景

磁共振扩散加权成像（DWI）是缺血性卒中诊断中最敏感的检查方式。然而，在一部分患者中，DWI可能无法检测到缺血性病变。

方法

按照系统评价与Meta分析的首选报告项目（PRISMA）声明，对Medline、Embase和Web of Science进行了系统检索，直至2024年1月3日。纳入标准仅限于报告充分的英文文献。汇总DWI阴性缺血性卒中的比例。对于二元变量，使用随机效应模型计算比值比（OR）。

结果

纳入了14项研究，共16268例临床诊断为缺血性卒中且有可用DWI结果的患者。DWI阴性组中19.6%的患者接受了静脉溶栓治疗（IVT），DWI阳性组中这一比例为15.3%。16%（95%CI：10%-24%；敏感性分析后：11%[95%CI：8%-15%]）的卒中患者被报告为DWI阴性缺血性卒中。在轻度卒中患者（美国国立卫生研究院卒中量表[NIHSS]评分≤5分）中，24%（95%CI：12%-42%）的患者DWI结果为阴性。DWI扫描阴性的预测因素包括后循环卒中、缺血性心脏病史、既往卒中或既往短暂性脑缺血发作史。心源性栓塞性卒中（OR，0.62，95%CI：0.41-0.93）和心房颤动病史增加了DWI结果为阳性的可能性（OR，0.56，95%CI：0.45-0.71）。与DWI阳性的患者相比，DWI阴性缺血性卒中患者获得良好功能结局（改良Rankin量表[mRS]评分为0-1分）的几率更高（OR，2.26；95%CI：1.03-4.92），卒中复发几率更低（OR，0.68；95%CI：0.48-0.96），严重残疾或死亡（mRS评分为3-6分）的几率更低（OR，0.44；95%CI：0.34-0.57）。IVT后症状性脑出血的发生率在两组之间相当。