Jin Yu, Bai Xi, Guo Da, Guo Zhiwei
Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, PR China.
Department of Radiology, The 3rd Affiliated Hospital of Chengdu Medical College & Pidu District People's Hospital, Chengdu, Sichuan, PR China.
Acta Radiol. 2025 Feb;66(2):218-227. doi: 10.1177/02841851241300328. Epub 2025 Jan 23.
Hyperperfusion is related to vessel recanalization, tissue reperfusion, and collateral circulation. To determine the prognostic impact of hyperperfusion after an acute ischemic stroke (AIS) identified by arterial spin labeling (ASL) cerebral blood flow. Studies published in PubMed, Embase, and Cochrane Library databases were searched. Studies assessing the diagnostic performance of ASL hyperperfusion after AIS were included. Functional prognosis, hemorrhagic transformation (HT), infarction volume, and penumbra salvage volume were evaluated. The standardized mean difference or risk ratio was pooled, implementing a random effect model. Multiple subgroup analyses were performed. Seven studies including 617 participants were included in this meta-analysis. ASL hyperperfusion in AIS was correlated well with symptom severity and outcome after 24 h National Institutes of Health Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS). Earlier ASL hyperperfusion was associated with a smaller infarction volume and a larger penumbra salvage volume, while also indicating a higher risk of HT. In addition, in subgroup analysis, our results demonstrated that thrombolysis, mechanical thrombectomy treatment, early improvement of NIHSS, and involving infarction in cortical territory are associated with ASL hyperperfusion. ASL hyperperfusion was related to a favorable functional outcome but an increased risk of HT. Stroke patients with hyperperfusion showed smaller infarction volume and larger penumbra salvage volume than those with non-hyperperfusion.
高灌注与血管再通、组织再灌注及侧支循环有关。为确定动脉自旋标记（ASL）脑血流识别的急性缺血性卒中（AIS）后高灌注对预后的影响。检索了发表在PubMed、Embase和Cochrane图书馆数据库中的研究。纳入评估AIS后ASL高灌注诊断性能的研究。评估功能预后、出血性转化（HT）、梗死体积和半暗带挽救体积。采用随机效应模型汇总标准化均数差或风险比。进行了多项亚组分析。本荟萃分析纳入了7项研究，共617名参与者。AIS中的ASL高灌注与24小时后美国国立卫生研究院卒中量表（NIHSS）和90天改良Rankin量表（mRS）的症状严重程度及预后密切相关。较早出现的ASL高灌注与较小的梗死体积和较大的半暗带挽救体积相关，同时也表明HT风险较高。此外，在亚组分析中，我们的结果表明，溶栓、机械取栓治疗、NIHSS的早期改善以及累及皮质区域的梗死与ASL高灌注有关。ASL高灌注与良好的功能预后相关，但HT风险增加。与非高灌注的卒中患者相比，高灌注的卒中患者梗死体积更小，半暗带挽救体积更大。
