University of Pennsylvania, Department of Neurology, Philadelphia, PA, USA.
University of Pennsylvania, Department of Neurology, Philadelphia, PA, USA.
J Stroke Cerebrovasc Dis. 2024 Oct;33(10):107857. doi: 10.1016/j.jstrokecerebrovasdis.2024.107857. Epub 2024 Jul 11.
Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the reduction in final infarct volume only accounts for 10-15 % of the treatment benefit. We aimed to develop a novel MRI-ADC-based metric that quantify the degree of tissue injury to test the hypothesis that it outperforms infarct volume in predicting long-term outcome.
A single-center cohort consisted of consecutive acute stroke patients with anterior circulation large vessel occlusion, successful recanalization via EVT (mTICI ≥2b), and MRI of the brain between 12 h and 7 days post-EVT. Imaging was processed via RAPID software. Final infarct volume was based on the traditional ADC <620 threshold. Logistic regression quantified the association of lesion volumes and good outcome (90-day modified Rankin Scale ≤2) at a range of lower ADC thresholds (<570, <520, and <470). Infarct density was calculated as the percentage of the final infarct volume below the ADC threshold with the greatest effect size. Univariate and multivariate logistic regression quantified the association between imaging/clinical metrics and functional outcome.
120 patients underwent MRI after successful EVT. Lesion volume based on the ADC threshold <470 had the strongest association with good outcome (OR: 0.81 per 10 mL; 95 % CI: 0.66-0.99). In a multivariate model, infarct density (<470/<620 * 100) was independently associated with good outcome (aOR 0.68 per 10 %; 95 % CI: 0.49-0.95), but final infarct volume was not (aOR 0.98 per 10 mL; 95 % CI: 0.85-1.14).
Infarct density after EVT is more strongly associated with long-term clinical outcome than infarct volume.
血管内血栓切除术（EVT）显著改善临床结局，但最终梗死体积的减少仅占治疗益处的 10-15%。我们旨在开发一种新的 MRI-ADC 为基础的指标来量化组织损伤程度，以检验其在预测长期预后方面优于梗死体积的假设。
单中心队列由连续的急性前循环大血管闭塞患者组成，通过 EVT 实现再通（mTICI≥2b），并在 EVT 后 12 小时至 7 天之间进行脑部 MRI。通过 RAPID 软件处理图像。最终梗死体积基于传统的 ADC<620 阈值。逻辑回归量化了病变体积与良好结局（90 天改良 Rankin 量表≤2）之间的关联，范围涵盖了一系列较低的 ADC 阈值（<570、<520 和<470）。梗死密度计算为 ADC 阈值以下的最终梗死体积占比，以获得最大的效果大小。单变量和多变量逻辑回归量化了影像学/临床指标与功能结局之间的关联。
120 例患者在成功 EVT 后进行了 MRI。基于 ADC 阈值<470 的病变体积与良好结局的相关性最强（OR：每 10 mL 减少 0.81；95%CI：0.66-0.99）。在多变量模型中，梗死密度（<470/<620*100）与良好结局独立相关（aOR 每 10%减少 0.68；95%CI：0.49-0.95），而最终梗死体积则没有（aOR 每 10 mL 增加 0.98；95%CI：0.85-1.14）。
EVT 后梗死密度与长期临床结局的相关性强于梗死体积。
