动脉自旋标记法检测到的充血与血管内治疗后中风的最终梗死体积相关。
Hyperemia detection on arterial spin labeling is associated with final infarct volume in stroke post-endovascular therapy.
作者信息
Lomahan Carolyn A, Luby Marie, Kalarakis Georgios, Hsia Amie W, Lynch John K, Nathani Karan P, Somani Sana, Thomas Leila C, Arnberg-Sandor Fabian, Latour Lawrence L
机构信息
Acute Cerebrovascular Diagnostics Unit - Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Acute Cerebrovascular Diagnostics Unit - Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
出版信息
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108358. doi: 10.1016/j.jstrokecerebrovasdis.2025.108358. Epub 2025 May 26.
BACKGROUND AND PURPOSE
Patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT) may develop hyperemia due to loss of relative cerebral blood flow (rCBF) autoregulation. Hyperemia can be detected on two types of MRI perfusion weighted imaging: dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL). The aim of this study was to compare hyperemia on ASL-rCBF to DSC-rCBF post-EVT and explore the association between hyperemia and final infarct volume (FIV).
METHODS
This is a retrospective analysis of the GUARDS cohort in the ongoing prospective Natural History of Stroke study (ClinicalTrials.gov Identifier: NCT00009243). Patients with AIS who met the following criteria were eligible for this analysis: (i) ≥ 18 years, (ii) no contraindication to 3T MRI, (iii) large vessel occlusion in the anterior circulation, (iv) attempted EVT, and (v) 3T MRI obtained at 24 hours, including DSC-rCBF and ASL-rCBF, and at 5 days post-EVT. Qualitative imaging analysis for hyperemia detection was performed by consensus between two independent raters. Quantitative imaging analysis assessed hyperemic tissue volume, FIV, and Dice coefficients between hyperemia and FIV masks.
RESULTS
Forty patients with median (IQR) age of 70 (62-81) years and admission NIHSS 16 (10-21) were included. Hyperemia was identified on ASL-rCBF in 40 % (16) of patients and on DSC-rCBF in 30 % (12). For 9 patients with hyperemia on both modalities, the ASL-rCBF and DSC-rCBF median volumes were 85.7 (19.4-144.9) and 58.1 (26.2-74.0) (p = 0.10). The Dice coefficient for hyperemia on ASL-rCBF and FIV was higher compared to DSC-rCBF, 0.60 (0.54-0.69) versus 0.39 (0.34-0.49).
CONCLUSION
Hyperemia volumes measured on ASL-rCBF, compared to DSC-rCBF, at 24 hours were more associated with FIV at 5 days. Hyperemia may be an indicator of impaired cerebral autoregulation and potential target for adjunctive therapy to mitigate infarct growth.
背景与目的
接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者可能因相对脑血流量（rCBF）自动调节功能丧失而出现充血。充血可在两种类型的MRI灌注加权成像上检测到：动态磁敏感对比（DSC）和动脉自旋标记（ASL）。本研究的目的是比较EVT后ASL-rCBF与DSC-rCBF上的充血情况，并探讨充血与最终梗死体积（FIV）之间的关联。
方法
这是对正在进行的前瞻性卒中自然史研究（ClinicalTrials.gov标识符：NCT00009243）中GUARDS队列的回顾性分析。符合以下标准的AIS患者有资格进行本分析：（i）年龄≥18岁，（ii）无3T MRI禁忌证，（iii）前循环大血管闭塞，（iv）尝试进行EVT，以及（v）在24小时时获得3T MRI，包括DSC-rCBF和ASL-rCBF，并在EVT后5天获得。由两名独立评估者达成共识进行充血检测的定性成像分析。定量成像分析评估充血组织体积、FIV以及充血与FIV掩码之间的骰子系数。
结果
纳入了40例患者，年龄中位数（IQR）为70（62 - 81）岁，入院时美国国立卫生研究院卒中量表（NIHSS）评分为16（10 - 21）。40%（16例）的患者在ASL-rCBF上发现充血，30%（12例）的患者在DSC-rCBF上发现充血。对于两种模式均有充血的9例患者，ASL-rCBF和DSC-rCBF的中位数体积分别为85.7（19.4 - 144.9）和58.1（26.2 - 74.0）（p = 0.10）。与DSC-rCBF相比，ASL-rCBF上充血与FIV的骰子系数更高，分别为0.60（0.54 - 0.69）和0.39（0.34 - 0.49）。
结论
与DSC-rCBF相比，24小时时ASL-rCBF测量的充血体积与5天时的FIV更相关。充血可能是脑自动调节功能受损的一个指标，也是减轻梗死灶扩大的辅助治疗的潜在靶点。
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