Takamiya Soichiro, Oura Daisuke, Ihara Riku, Niiya Yoshimasa, Furukawa Koji, Gekka Masayuki, Nakazaki Asuka, Fujimura Miki
Department of Neurosurgery, Otaru General Hospital, Otaru, Japan.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Neuroradiology. 2024 Dec;66(12):2205-2213. doi: 10.1007/s00234-024-03463-3. Epub 2024 Sep 19.
The aims of this study are to explore the apparent diffusion coefficient (ADC)-dependent thresholds for time to reperfusion in reversible lesions following mechanical thrombectomy for acute ischemic stroke, and to investigate the associated risks of hemorrhagic transformation.
We conducted a retrospective case-control study, enrolling patients with large-vessel occlusion who underwent mechanical thrombectomy in Otaru General Hospital from 2016 to 2021. Reversible lesions were identified using volumetric ADC data, and the mean time from image to reperfusion (TIR) in each ADC range was compared between groups with and without reversible lesions, as well as those with and without parenchymal hematoma. The Wilcoxon rank sum test and chi-square test were used for comparison between two groups, and receiver operating characteristic curves were created to determine optimal thresholds.
Seventy-five patients were included and 581 volumetric data were obtained. The mean TIR in the group with reversible lesions was shorter than in that without, and time thresholds were 131, 123 and 112 min for ADC values > 540 × 10, 500-540 × 10 and 440-500 × 10 mm/s, respectively. Furthermore, in patients with parenchymal hematoma, the mean TIR was significantly longer, and the average ADC value was significantly lower than those without hematoma.
The time thresholds for the irreversible ischemic core may vary depending on the ADC value, and they may be shorter when the ADC value is lower. Moreover, both the low ADC value and the late reperfusion might be associated with an increased risk of parenchymal hematoma.
本研究旨在探讨急性缺血性卒中机械取栓术后可逆性病灶再灌注时间的表观扩散系数（ADC）依赖性阈值，并研究出血性转化的相关风险。
我们进行了一项回顾性病例对照研究，纳入2016年至2021年在小樽综合医院接受机械取栓的大血管闭塞患者。使用容积ADC数据识别可逆性病灶，并比较有可逆性病灶组和无可逆性病灶组以及有和无实质血肿组在每个ADC范围内从图像到再灌注的平均时间（TIR）。两组之间的比较采用Wilcoxon秩和检验和卡方检验，并绘制受试者工作特征曲线以确定最佳阈值。
纳入75例患者，获得581份容积数据。有可逆性病灶组的平均TIR短于无可逆性病灶组，ADC值>540×10、500 - 540×10和440 - 500×10 mm/s时的时间阈值分别为131、123和112分钟。此外，有实质血肿的患者平均TIR显著更长，平均ADC值显著低于无血肿患者。
不可逆缺血核心的时间阈值可能因ADC值而异，ADC值越低可能越短。此外，低ADC值和延迟再灌注可能都与实质血肿风险增加有关。
