Schwamm L H, Koroshetz W J, Sorensen A G, Wang B, Copen W A, Budzik R, Rordorf G, Buonanno F S, Schaefer P W, Gonzalez R G
Departmentof Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass. 02114, USA.
Stroke. 1998 Nov;29(11):2268-76. doi: 10.1161/01.str.29.11.2268.
We sought to characterize the evolution of acute ischemic stroke by MRI and its relationship to patients' neurological outcome.
Fourteen patients with acute ischemic stroke underwent MRI within 13 hours of symptom onset (mean, 7.4+/-3 hours) and underwent repeated imaging and concurrent neurological examination at 8, 24, 36, and 48 hours and 7 days and >42 days after first imaging.
Diffusion-weighted imaging (DWI) lesion volumes increased between the first and second scans in 10 of 14 patients; scans with maximum DWI lesion volume occurred at a mean of 70.4 hours. Initial DWI lesion volume correlated with the largest T2 lesion volume (r=0.97; P<0.001). Final lesion volume was smaller than maximum lesion volume in 12 of 14 patients. There was positive correlation between the follow-up National Institutes of Health Stroke Scale score and the initial DWI lesion volume (r=0.67; P=0. 01) and maximum T2 lesion volume (r=0.77; P<0.01) and negative correlation with initial mean apparent diffusion coefficient ratio (ADCr) (r=-0.64; P<0.05). The ADCr was 0.73 at initial imaging and fell between the initial and second scans in 10 of 14 patients. Mean ADCr did not rise above normal until 42 days after stroke onset (P<0. 001).
Serial MRI demonstrates the dynamic nature of progressive ischemic injury in acute stroke patients developing over hours to days, and it suggests that both primary and secondary pathophysiological processes can be valuable targets for neuroprotective interventions.
我们试图通过磁共振成像（MRI）来描述急性缺血性卒中的演变过程及其与患者神经功能转归的关系。
14例急性缺血性卒中患者在症状发作后13小时内（平均7.4±3小时）接受了MRI检查，并在首次成像后的8、24、36和48小时以及7天和超过42天时接受了重复成像及同步神经学检查。
14例患者中有10例在首次和第二次扫描之间弥散加权成像（DWI）病变体积增加；DWI病变体积最大的扫描平均出现在70.4小时。初始DWI病变体积与最大T2病变体积相关（r = 0.97；P < 0.001）。14例患者中有12例最终病变体积小于最大病变体积。随访的美国国立卫生研究院卒中量表评分与初始DWI病变体积（r = 0.67；P = 0.01）和最大T2病变体积（r = 0.77；P < 0.01）呈正相关，与初始平均表观扩散系数比值（ADCr）呈负相关（r = -0.64；P < 0.05）。初始成像时ADCr为0.73，14例患者中有10例在首次和第二次扫描之间ADCr下降。平均ADCr直到卒中发作后42天才升至正常水平（P < 0.001）。
系列MRI显示了急性卒中患者数小时至数天内进行性缺血性损伤的动态性质，提示原发性和继发性病理生理过程均可能是神经保护干预的重要靶点。
