Toko Megumi, Nezu Tomohisa, Eto Futoshi, Aoki Shiro, Ohshita Tomohiko, Ueno Hiroki, Akiyama Yuji, Maruyama Hirofumi
Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (M.T., T.N., S.A., H.M.).
Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan (F.E., H.U.).
Stroke. 2025 Mar;56(3):649-656. doi: 10.1161/STROKEAHA.124.049851. Epub 2025 Jan 14.
Synthetic magnetic resonance imaging (MRI) is an innovative MRI technology that enables the acquisition of multiple quantitative values, including T1 and T2 values, proton density, and myelin volume, in a single scan. Although the usefulness of myelin measurement with synthetic MRI has been reported for assessing several diseases, investigations in patients with stroke have not been reported. We aimed to explore the utility of myelin quantification using synthetic MRI in predicting outcomes in patients with acute ischemic stroke.
Patients with acute ischemic stroke (n=101) with a premorbid modified Rankin Scale score ≤2 were enrolled. We performed MRI with a 3 T scanner, acquiring synthetic MRI data in addition to data acquired using the routine protocol; we measured total myelin volume (TMV) using synthetic MRI software. After hospitalization, a synthetic MRI was performed when the patient's condition was stable, with a median of 7 days from onset to MRI. We examined the factors related to good stroke outcomes (defined by a modified Rankin Scale score of ≤2 at 3 months).
Patients with larger TMV were younger, were more frequently male, and had higher body mass index. In addition, TMV was associated with the severity of white matter hyperintensities and total small vessel burden scores. The patients with good outcomes (n=66) had larger TMVs than those without (144.85±22.19 versus 126.62±21.81 mL, <0.001). Multivariable analysis revealed that the TMV quartiles were independently associated with good functional outcomes (odds ratio, 2.54 [95% CI, 1.12-6.70]; =0.025) after adjusting for baseline clinical characteristics including initial stroke severity, acute brain infarct volume, and brain parenchymal volume.
A large TMV quantified using synthetic MRI was independently associated with good functional outcomes after adjusting for several confounding factors. TMV, which suggests the validity of myelin quantification, might be a useful indicator for predicting stroke outcomes.
合成磁共振成像（MRI）是一种创新的MRI技术，能够在单次扫描中获取多个定量值，包括T1和T2值、质子密度和髓磷脂体积。尽管已经报道了合成MRI测量髓磷脂在评估多种疾病中的有用性，但尚未有关于中风患者的研究报道。我们旨在探讨使用合成MRI进行髓磷脂定量在预测急性缺血性中风患者预后中的效用。
纳入101例病前改良Rankin量表评分≤2的急性缺血性中风患者。我们使用3T扫描仪进行MRI检查，除了使用常规方案获取的数据外，还获取合成MRI数据；我们使用合成MRI软件测量总髓磷脂体积（TMV）。住院后，在患者病情稳定时进行合成MRI检查，从发病到MRI的中位时间为7天。我们检查了与良好中风预后（定义为3个月时改良Rankin量表评分≤2）相关的因素。
TMV较大的患者更年轻，男性更常见，体重指数更高。此外，TMV与白质高信号的严重程度和总小血管负荷评分相关。预后良好的患者（n = 66）的TMV大于预后不良的患者（144.85±22.19对126.62±21.81 mL，<0.001）。多变量分析显示，在调整包括初始中风严重程度（急性脑梗死体积和脑实质体积）在内的基线临床特征后，TMV四分位数与良好的功能预后独立相关（优势比，2.54 [95% CI，1.12 - 6.70]；P = 0.025）。
在调整了几个混杂因素后，使用合成MRI定量的大TMV与良好的功能预后独立相关。TMV提示了髓磷脂定量的有效性，可能是预测中风预后的有用指标。
