Li Qiuxuan, Bai Xuesong, Yu Fan, Lu Yao, Zhang Miao, Li Jingkai, Li Yuan, Tian Qiuyue, Dmytriw Adam A, Regenhardt Robert W, Jiao Liqun, Lu Jie
Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
J Neuroimaging. 2025 May-Jun;35(3):e70045. doi: 10.1111/jon.70045.
The Alberta Stroke Program Early CT Score-based net water uptake (ASPECTS-NWU) is a quantitative imaging biomarker used to assess early ischemic changes in acute ischemic stroke patients. ASPECTS-NWU has been investigated in identifying stroke onset time, measuring ischemic tissue edema, and predicting functional outcomes. However, the mediating effect of ASPECTS-NWU and its association with collaterals, infarct volume, and functional outcome still need to be explored. Therefore, we hypothesized that ASPECTS-NWU is a mediator between collateral circulation and infarct volume and investigated their association with outcome.
There were 201 patients, and 131 of them underwent mechanical thrombectomy. Collaterals were graded using the multiphase Menon score. The mediating effect of ASPECTS-NWU between collaterals and infarct volume was investigated. The association between infarct volume, collaterals, recanalization status, and functional outcome was assessed by univariable and multivariate logistic regression analysis.
Patients with good collaterals displayed higher ASPECTS, lower ASPECTS-NWU, lower National Institute of Health Stroke Scale score at admission (NIHSS), and smaller infarct volume, ischemic tissue volume, and penumbra volume. ASPECTS-NWU was a mediator between collaterals and infarct volume, and the contribution rate of the mediator was 27.9%. In multivariate logistic regression analysis, infarct volume and recanalization status were associated with functional outcomes.
ASPECTS-NWU was a mediator and played a partial role between collaterals and infarct volume. Infarct volume and recanalization status were strong predictors of functional outcome. ASPECTS-NWU and collaterals indirectly influenced functional outcomes by regulating infarct volume.
基于阿尔伯塔卒中项目早期CT评分的净水摄取量（ASPECTS-NWU）是一种定量成像生物标志物，用于评估急性缺血性卒中患者的早期缺血性变化。ASPECTS-NWU已被用于确定卒中发病时间、测量缺血组织水肿以及预测功能结局。然而，ASPECTS-NWU的中介作用及其与侧支循环、梗死体积和功能结局的关联仍有待探索。因此，我们假设ASPECTS-NWU是侧支循环与梗死体积之间的中介，并研究了它们与结局的关联。
共有201例患者，其中131例接受了机械取栓术。使用多期梅农评分对侧支循环进行分级。研究了ASPECTS-NWU在侧支循环与梗死体积之间的中介作用。通过单变量和多变量逻辑回归分析评估梗死体积、侧支循环、再通状态与功能结局之间的关联。
侧支循环良好的患者ASPECTS评分较高、ASPECTS-NWU较低、入院时美国国立卫生研究院卒中量表（NIHSS）评分较低，梗死体积、缺血组织体积和半暗带体积较小。ASPECTS-NWU是侧支循环与梗死体积之间的中介，中介贡献率为27.9%。在多变量逻辑回归分析中，梗死体积和再通状态与功能结局相关。
ASPECTS-NWU是侧支循环与梗死体积之间的中介，发挥了部分作用。梗死体积和再通状态是功能结局的强预测因素。ASPECTS-NWU和侧支循环通过调节梗死体积间接影响功能结局。
