Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
J Neuroimaging. 2024 Nov-Dec;34(6):766-772. doi: 10.1111/jon.13235. Epub 2024 Sep 2.
Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients' quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored.
We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge.
The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002).
Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.
孤立性大脑后动脉（PCA）闭塞引起的缺血性脑卒中占所有脑卒中的 5%，但对患者的生活质量有重大影响，主要是因为视力缺陷和丘脑受累。目前针对急性 PCA 闭塞管理的指南很少，灌注成像参数的预后价值仍未得到充分探索。
我们对 2017 年 1 月至 2023 年 3 月在约翰霍普金斯医疗中心接受治疗的 32 例孤立性 PCA 闭塞患者进行了回顾性分析。患者在治疗前接受了灌注成像检查，使用 RAPID 软件对灌注参数进行分析。主要结局是通过出院时的国立卫生研究院卒中量表（NIHSS）评估的短期临床结局。
该队列的中位年龄为 70 岁，女性占 34%，男性占 66%。出院时 NIHSS 与各种灌注参数之间存在显著相关性，包括达峰时间（Tmax）>6 秒（ρ=.55，p=.004）、Tmax>8 秒（ρ=.59，p=.002）、Tmax>10 秒（ρ=.6，p=.001）、不匹配体积（ρ=.51，p=.008）和脑血容量（CBV）<34%（ρ=.59，p=.002）。
Tmax 和 CBV 体积与出院 NIHSS 显著相关，Tmax>10 秒和 CBV<42%体积具有边缘优势。这些发现表明 CT 和 MR 灌注成像可以在 PCA 卒中的急性管理中发挥关键作用，尽管需要更大、标准化的研究来验证这些结果，并细化针对后循环梗死的成像阈值。
