Jiang Meien, Li Guomin, He Qinmeng, Zhang Yulin, Li Wuming, Gao Yunyu, Yan Jianhao
Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China.
Quant Imaging Med Surg. 2024 Jul 1;14(7):4763-4778. doi: 10.21037/qims-24-153. Epub 2024 Jun 27.
Early neurologic deterioration occurs in up to one-third of patients with acute ischemic stroke (IS), often leading to poor functional outcomes. At present, few studies have applied amide proton transfer (APT) imaging to the evaluation of early neurological deterioration (END). This study analyzed the value of computed tomography perfusion (CTP) combined with multimodal magnetic resonance imaging (MRI) in patients with acute IS with END.
This retrospective study included patients with acute IS who were admitted to the neurology inpatient department in a tertiary hospital from October 2021 to June 2023. Patients with acute IS underwent CTP within 24 hours of stroke onset and MRI [arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), and APT] within 7 days. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 7 days of stroke onset. Univariable and multivariable analyses were used to compare clinical and imaging biomarkers in patients with acute IS with and without END. The performance of potential biomarkers in distinguishing between the two groups was evaluated using receiver operating characteristic (ROC) curve analysis.
Among the 70 patients with acute IS, 20 (29%) had END. After conducting univariable analysis, variables were selected for entry into a binary logistic regression analysis based on our univariable analysis results, previous research findings, clinical experience, and methodological standards. The results indicated that relative cerebral blood volume (CBV) on CTP, relative cerebral blood flow (CBF) on ASL, and relative signal intensity on amide proton transfer-weighted (APTw) imaging were independent risk factors for END. The areas under the ROC curves for these risk factors were 0.710 [95% confidence interval (CI): 0.559-0.861, P=0.006], 0.839 (95% CI: 0.744-0.933, P<0.001), and 0.804 (95% CI: 0.676-0.932, P<0.001), respectively. The combined area under the curve (AUC), sensitivity, and specificity of the four indices (0.941, 100%, and 78%, respectively) were higher than those of the four indices alone.
CTP combined with multi-modal MRI better evaluated hemodynamics, tissue metabolism, and other relevant patient information, providing an objective basis for the clinical assessment of patients with acute IS with END and facilitating the development of accurate and personalized treatment plans.
高达三分之一的急性缺血性卒中（IS）患者会出现早期神经功能恶化，这通常会导致不良的功能结局。目前，很少有研究将酰胺质子转移（APT）成像应用于早期神经功能恶化（END）的评估。本研究分析了计算机断层扫描灌注（CTP）联合多模态磁共振成像（MRI）在急性IS合并END患者中的价值。
这项回顾性研究纳入了2021年10月至2023年6月在一家三级医院神经内科住院的急性IS患者。急性IS患者在卒中发作后24小时内接受CTP检查，并在7天内接受MRI检查[动脉自旋标记（ASL）、磁敏感加权成像（SWI）和APT]。END定义为卒中发作后7天内美国国立卫生研究院卒中量表（NIHSS）评分升高≥2分。采用单变量和多变量分析比较急性IS合并和不合并END患者的临床和影像学生物标志物。使用受试者工作特征（ROC）曲线分析评估潜在生物标志物在区分两组患者中的性能。
在70例急性IS患者中，20例（29%）出现END。在进行单变量分析后，根据我们的单变量分析结果、先前的研究发现、临床经验和方法学标准，选择变量纳入二元逻辑回归分析。结果表明，CTP上的相对脑血容量（CBV）、ASL上的相对脑血流量（CBF）以及酰胺质子转移加权（APTw）成像上的相对信号强度是END的独立危险因素。这些危险因素的ROC曲线下面积分别为0.710[95%置信区间（CI）：0.559 - 0.861，P = 0.006]、0.839（95%CI：0.744 - 0.933，P < 0.001）和0.804（95%CI：0.676 - 0.932，P < 0.001）。四个指标的联合曲线下面积（AUC）、敏感性和特异性（分别为0.941、100%和78%）高于单独的四个指标。
CTP联合多模态MRI能更好地评估血流动力学、组织代谢及其他相关患者信息，为急性IS合并END患者的临床评估提供客观依据，有助于制定准确的个性化治疗方案。
