Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107949. doi: 10.1016/j.jstrokecerebrovasdis.2024.107949. Epub 2024 Aug 17.
Pre- and post-endovascular treatment (EVT) imaging may aid in predicting functional outcomes in acute middle cerebral artery (MCA) ischemic stroke. Low post-EVT contrast extravasation (CE)-ASPECTS is associated with poor functional outcomes. Besides the MCA regions included in the ASPECTS score, CE may be seen in the mesial temporal (MT) region. In this study, we investigated the frequency and prognostic implication of MT-CE in acute ischemic stroke patients.
Patients with an acute ischemic stroke due to anterior large vessel occlusion who received EVT and post-EVT DECT between 2010 and 2019 were included. Iodine overlay maps of DECT were assessed for the occurrence of CE, using the ASPECTS for occurrence in the MCA region and, calculating a CE-ASPECTS, for whether the MT region was involved. Multivariable linear and logistic regression were used to assess the relationship between involvement of MT-CE and 24-48h NIHSS, mRS, and mortality on a multiple imputed dataset. All models were adjusted significant variables in univariate analyses and for total CE-ASPECTS.
501/651 patients met the inclusion criteria. MT-CE occurred in 97 (19 %) patients, and was more often present in patients with internal carotid artery occlusions. MT-CE was associated with higher NIHSS scores at 24-hours (aβ 2.2, 95 % CI 0.09-4.31), with increased risk of higher mRS scores (acOR 1.88, 95 % CI 1.16-3.06), and with increased risk of mortality (aOR 2.12, 95 % CI 1.16-3.86).
MT-CE is a common finding on post-EVT DECT and is an independent predictor for worse functional outcomes.
血管内治疗（EVT）前后的影像学检查可能有助于预测急性大脑中动脉（MCA）缺血性卒中的功能结局。低血管外渗（CE）-ASPECTS 与不良的功能结局相关。除了 ASPECTS 评分中包含的 MCA 区域外，CE 也可能出现在内侧颞叶（MT）区域。在这项研究中，我们研究了急性缺血性卒中患者 MT-CE 的发生频率及其预后意义。
纳入了 2010 年至 2019 年期间因前循环大血管闭塞接受 EVT 和 post-EVT 双能 CT（DECT）的急性缺血性卒中患者。使用 ASPECTS 评估 DECT 的碘覆盖图中 MCA 区域 CE 的发生情况，并计算 CE-ASPECTS，以评估 MT 区域是否受累。使用多变量线性和逻辑回归评估 MT-CE 受累与 24-48 小时 NIHSS、mRS 和死亡率之间的关系，在多个插补数据集上进行分析。所有模型均调整了单变量分析中的显著变量和总 CE-ASPECTS。
501/651 例患者符合纳入标准。97 例（19%）患者出现 MT-CE，颈内动脉闭塞患者更常见。MT-CE 与 24 小时 NIHSS 评分较高相关（aβ 2.2，95%CI 0.09-4.31），与 mRS 评分较高的风险增加相关（acOR 1.88，95%CI 1.16-3.06），与死亡率增加相关（aOR 2.12，95%CI 1.16-3.86）。
MT-CE 是 post-EVT DECT 上的常见发现，是功能结局较差的独立预测因素。
