Mohamed Sherif A, Adlung Anne, Ludwig Nadia K, Samartzi Melina, Schad Lothar R, Fatar Marc, Neumaier-Probst Eva
Department of Neuroradiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Cerebrovasc Dis. 2025;54(4):441-451. doi: 10.1159/000540162. Epub 2024 Jul 25.
Ischemic cerebral stroke initiates a complex cascade of pathophysiological events, involving various forms of molecular shifts and edema. Early intervention is pivotal in minimizing tissue loss and improving clinical outcomes. This study explores the temporal and spatial evolution of tissue sodium concentration (TSC) in acute ischemic lesions after acute therapy using 23Na-MRI in addition to conventional 1H-MRI.
Prospectively, from examined 58 patients with acute ischemic stroke with a combined 1H/23Na-MRI within 72 h of symptom onset after receiving acute therapy, 31 patients were included in the evaluation of this study. After co-registration of the 23Na-MRI images to the morphological 1H-MRI images, manual segmentation of the ischemic lesions was performed, and the ADC and TSC measurements were quantified and correlated with the time of onset and lesion volume.
The mean TSC in ischemic lesions correlated positively with lesion volume (r = 0.52, p = 0.002) and showed a significant association with the time of stroke onset (r = 0.8, p < 0.001). Patients who were treated only with intravenous rtPA showed homogenous sodium signal intensity in the ischemic lesions, whereas the patients who received mechanical recanalization exhibited distinctive sodium signal intensity patterns with focal significant TSC differences.
The integration of 1H- and 23Na-MRI provides a nuanced understanding of temporal and spatial changes due to different types of edema in ischemic stroke lesions following acute treatment. Further exploration of these findings may enhance our understanding of stroke pathophysiology and guide personalized therapeutic interventions.
缺血性脑卒引发一系列复杂的病理生理事件，涉及多种分子变化和水肿形式。早期干预对于减少组织损伤和改善临床结局至关重要。本研究除常规1H-MRI外，还使用23Na-MRI探讨急性治疗后急性缺血性病变中组织钠浓度（TSC）的时空演变。
前瞻性地，在对58例急性缺血性脑卒中患者在症状发作72小时内接受急性治疗后进行联合1H/23Na-MRI检查，其中31例患者纳入本研究评估。将23Na-MRI图像与形态学1H-MRI图像配准后，对缺血性病变进行手动分割，并对表观扩散系数（ADC）和TSC测量值进行量化，并与发病时间和病变体积相关联。
缺血性病变中的平均TSC与病变体积呈正相关（r = 0.52，p = 0.002），并与脑卒中发病时间呈显著相关性（r = 0.8，p < 0.001）。仅接受静脉注射重组组织型纤溶酶原激活剂（rtPA）治疗的患者在缺血性病变中显示出均匀的钠信号强度，而接受机械再通治疗的患者表现出独特的钠信号强度模式，局部TSC存在显著差异。
1H-MRI和23Na-MRI的结合可更细致地了解急性治疗后缺血性脑卒中病变中不同类型水肿引起的时空变化。对这些发现的进一步探索可能会加深我们对脑卒中病理生理学的理解，并指导个性化治疗干预。
