Zhao Chenxi, Cao Chen, Ren Lei, Wang Huiying, Wu Gemuer, Fu Dingwei, Zhu Jinxia, Chai Chao, Guo Yu, Xia Shuang
Department of Radiology, The First Central Clinical School, Tianjin Medical University, Tianjin, China.
Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China.
Quant Imaging Med Surg. 2025 Mar 3;15(3):2053-2064. doi: 10.21037/qims-24-1560. Epub 2025 Feb 26.
Currently, the selection of patients with acute anterior large vessel occlusions (LVOs) for endovascular thrombectomy (EVT) is primarily based on dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) or computed tomography (CT) perfusion imaging. This study investigated the consistency between hypoperfused tissue (HPT) (time to maximum >6 s, Tmax >6 s) volumes estimated by corrected and uncorrected multidelay pseudo-continuous arterial spin labeling (pCASL) and DSC-PWI in patients with anterior LVOs and also evaluated the diagnostic performances in selecting patients with acute LVOs for EVT.
This retrospective study enrolled patients with acute (n=108) and symptomatic chronic (n=90) LVOs. Shapiro-Wilk tests and receiver operating characteristic (ROC) analyses were used. Intraclass correlation coefficient (ICC) compared the consistency of HPT volume calculated by DSC-PWI and multidelay pCASL.
Multidelay pCASL with different thresholds in acute LVOs were 128.8 [interquartile range (IQR), 76.2-181.1] mL in uncorrected relative cerebral blood flow (rCBF) <40%, 84.1 (IQR, 36.8-133.9) mL in uncorrected CBF <20 mL·100 g·min and 74.4 (IQR, 26.2-118.0) mL in corrected CBF <20 mL·100 g·min, which were comparable to the volume of 69.5 (IQR, 20.0-121.4) mL automatically determined by Tmax >6 s in DSC-PWI, and showed substantial consistency after correction (ICC =0.742). Multidelay pCASL with different thresholds in symptomatic chronic LVOs was 78.3 (IQR, 53.5-129.4) mL, 59.8 (IQR, 16.6-98.5) mL and 36.4 (IQR, 10.1-85.3) mL, which were comparable to the volume of 0 (IQR, 0-36.4) mL in DSC-PWI, and showed substantial consistency after correction (ICC =0.617). Using DEFUSE 3 as the reference standard, the CBF corrected by arterial transit time (ATT) showed good performance in selecting patients for EVT (area under the curve 0.804, 95% confidence interval: 0.717-0.891).
The volume of HPT defined by corrected CBF <20 mL·100 g·min is consistent with that of DSC-PWI in acute and chronic symptomatic LVOs patients. Multidelay pCASL adjusted by ATT is more applicable to clinical routine.
目前，急性前循环大血管闭塞（LVO）患者血管内血栓切除术（EVT）的选择主要基于动态磁敏感对比灌注加权成像（DSC-PWI）或计算机断层扫描（CT）灌注成像。本研究调查了前循环LVO患者中，校正和未校正的多延迟伪连续动脉自旋标记（pCASL）所估计的低灌注组织（HPT）（达峰时间>6秒，Tmax>6秒）体积与DSC-PWI之间的一致性，并评估了在选择急性LVO患者进行EVT时的诊断性能。
这项回顾性研究纳入了急性（n=108）和症状性慢性（n=90）LVO患者。使用了夏皮罗-威尔克检验和受试者工作特征（ROC）分析。组内相关系数（ICC）比较了DSC-PWI和多延迟pCASL计算的HPT体积的一致性。
急性LVO中，不同阈值的多延迟pCASL在未校正相对脑血流量（rCBF）<40%时为128.8[四分位数间距（IQR），76.2-181.1]mL，未校正脑血流量<20 mL·100 g·min时为84.1（IQR，36.8-133.9）mL，校正后脑血流量<20 mL·100 g·min时为74.4（IQR，26.2-118.0）mL，与DSC-PWI中Tmax>6秒自动确定的69.5（IQR，20.0-121.4）mL体积相当，校正后显示出高度一致性（ICC =0.742）。症状性慢性LVO中，不同阈值的多延迟pCASL为78.3（IQR，53.5-129.4）mL、59.8（IQR，16.6-98.5）mL和36.4（IQR，10.1-85.3）mL，与DSC-PWI中的0（IQR，0-36.4）mL体积相当，校正后显示出高度一致性（ICC =0.617）。以DEFUSE 3为参考标准，经动脉通过时间（ATT）校正的脑血流量在选择EVT患者方面表现良好（曲线下面积0.804，95%置信区间：0.717-0.891）。
在急性和慢性症状性LVO患者中，校正后脑血流量<20 mL·100 g·min所定义的HPT体积与DSC-PWI的体积一致。经ATT调整的多延迟pCASL更适用于临床常规。
