Diamandi Julia, Raimondo Christian, Piper Keenan, Roy Joanna, Serva Stephanie, Alizadeh Mahdi, Flanders Adam, Tjoumakaris Stavropoula, Gooch Reid, Jabbour Pascal, Rosenwasser Robert, Mouchtouris Nikolaos
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Neuroimage Clin. 2025;45:103742. doi: 10.1016/j.nicl.2025.103742. Epub 2025 Jan 24.
This study aims to assess whether water exchange rate (k), a surrogate for blood-brain barrier (BBB) permeability, is associated with functional outcomes in patients with acute ischemic stroke (AIS).
We studied 22 AIS patients enrolled from 1/2022 to 4/2024 who underwent multi-modal non-contrast imaging on a 3.0-Tesla scanner, including DP-pCASL, DTI, NODDI and MAP imaging. For each parametric map, the intensity and standard deviation (SD) were calculated for the infarcted region. The diffusion maps included were b0, Fractional Anisotropy (FA), Mean Diffusivity (MD), Intra-cellular Volume Fraction (ICVF), Free Water Fraction (FWF), and Orientation Dispersion Index (ODI), q-Space Mean Square Displacement (QMSD), Return-to-Axis Probability (RTAP), Return-to-Plane Probability (RTPP), Return-to-Origin Probability (RTOP), Propagator Anisotropy (PA), and non-Gaussianity (NG). The perfusion-based maps were cerebral blood flow (CBF), arterial transit time (ATT), and k. The outcome variable was modified Rankin Scale (mRS).
Twenty-two patients were included. The average age was 69.5 ± 13.5, the mean NIHSS of 12.4 ± 7.7, and the median infarct of 25.7 (8.4-98.8) ml. Multivariable linear regression identified lower k (β = -0.029, p = 0.041), longer time to MRI (β = 0.012, p = 0.013) and larger stroke volume (β = 0.014, p = 0.006) as predictive of higher mRS. Higher CBF (β = 0.660, p = 0.003) and RTAP (β = 1.528, p = 0.010), and lower SD RTAP (β = -0.709, p = 0.016), RTPP (β = -2.132, p = 0.006), and NG (β = -1.036, p = 0.011) were identified as most predictive of k through multivariable linear regression analysis.
Lower k is predictive of higher mRS in patients with AIS. Increasing CBF and RTAP and lower SD RTAP, RTPP, and NG were correlated with higher k.
本研究旨在评估水交换率（k），即血脑屏障（BBB）通透性的替代指标，是否与急性缺血性卒中（AIS）患者的功能结局相关。
我们研究了2022年1月至2024年4月纳入的22例AIS患者，这些患者在3.0特斯拉扫描仪上接受了多模态非对比成像，包括双极性动脉自旋标记（DP-pCASL）、扩散张量成像（DTI）、神经突方向离散与密度成像（NODDI）和磁共振弹性成像（MAP）。对于每个参数图，计算梗死区域的强度和标准差（SD）。纳入的扩散图包括b0、分数各向异性（FA）、平均扩散率（MD）、细胞内体积分数（ICVF）、自由水分数（FWF）、方向离散指数（ODI）、q空间均方位移（QMSD）、回轴概率（RTAP）、回平面概率（RTPP）、回原点概率（RTOP）、传播子各向异性（PA）和非高斯性（NG）。基于灌注的图包括脑血流量（CBF）、动脉通过时间（ATT）和k。结局变量为改良Rankin量表（mRS）。
纳入22例患者。平均年龄为69.5±13.5岁，美国国立卫生研究院卒中量表（NIHSS）平均评分为12.4±7.7分，梗死灶中位数为25.7（8.4 - 98.8）ml。多变量线性回归分析确定较低的k（β = -0.029，p = 0.041）、较长的MRI检查时间（β = 0.012，p = 0.013）和较大的卒中体积（β = 0.014，p = 0.006）可预测较高的mRS。通过多变量线性回归分析确定，较高的CBF（β = 0.660，p = 0.003）和RTAP（β = 1.528，p = 0.010），以及较低的SD RTAP（β = -0.709，p = 0.016）、RTPP（β = -2.132，p = 0.006）和NG（β = -1.036，p = 0.011）最能预测k。
较低的k可预测AIS患者较高的mRS。CBF和RTAP增加以及SD RTAP、RTPP和NG降低与较高的k相关。
