Hanson S K, Grotta J C, Rhoades H, Tran H D, Lamki L M, Barron B J, Taylor W J
Department of Neurology, University of Texas Health Science Center, Houston 77030.
Stroke. 1993 Sep;24(9):1322-9. doi: 10.1161/01.str.24.9.1322.
New therapeutic interventions for acute ischemic stroke are aimed at improving cerebral blood flow in the first 3 to 6 hours after symptom onset. Single-photon emission-computed tomography (SPECT) performed in the setting of clinical therapeutic trials may give us a better understanding of the physiological response to new forms of treatment and could impact acute management decisions.
We prospectively studied 15 patients with hemispheric ischemic stroke with SPECT within 6 hours of symptom onset and again at 24 hours. The ischemic defect was assessed in a semiquantitative manner that used computer-generated regions of interest (SPECT graded scale). This measure was correlated with clinical presentation (National Institutes of Health [NIH] Stroke Scale), initial clinical course (change in NIH Stroke Scale), long-term outcome (Barthel Index at 3 months), and complications of cerebral hemorrhage and edema.
The severity of the SPECT graded scale on the admission scan correlated with the severity of neurological deficit (admission NIH Stroke Scale) (P < .05) and was positively associated with poor long-term outcome as measured with the Barthel Index (P < .001) and the complications of cerebral hemorrhage and massive cerebral edema (P < .005). In fact, there was a threshold value for the SPECT graded scale above which all patients suffered poor long-term outcome and the complications of cerebral hemorrhage and edema.
The measurement of an ischemic defect using SPECT is a valid assessment of hemispheric stroke severity in the hyperacute setting and may be useful for selecting or stratifying patients in clinical therapeutic trials.
急性缺血性卒中的新治疗干预措施旨在改善症状发作后最初3至6小时内的脑血流量。在临床治疗试验中进行的单光子发射计算机断层扫描（SPECT）可能会让我们更好地了解对新治疗形式的生理反应，并可能影响急性管理决策。
我们前瞻性地研究了15例半球缺血性卒中患者，在症状发作6小时内进行SPECT检查，并在24小时时再次检查。采用计算机生成的感兴趣区域（SPECT分级量表）以半定量方式评估缺血缺损。该测量值与临床表现（美国国立卫生研究院卒中量表）、初始临床病程（美国国立卫生研究院卒中量表变化）、长期预后（3个月时的巴氏指数）以及脑出血和水肿并发症相关。
入院扫描时SPECT分级量表的严重程度与神经功能缺损的严重程度（入院时美国国立卫生研究院卒中量表）相关（P < 0.05），并且与用巴氏指数测量的不良长期预后呈正相关（P < 0.001）以及与脑出血和大面积脑水肿并发症呈正相关（P < 0.005）。事实上，SPECT分级量表存在一个阈值，高于该阈值的所有患者都有不良的长期预后以及脑出血和水肿并发症。
使用SPECT测量缺血缺损是超急性期半球卒中严重程度的有效评估方法，可能有助于在临床治疗试验中选择患者或对患者进行分层。
