Hyperemia detection on arterial spin labeling is associated with final infarct volume in stroke post-endovascular therapy

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-05-26 DOI:10.1016/j.jstrokecerebrovasdis.2025.108358

Carolyn A. Lomahan BS , Marie Luby PhD , Georgios Kalarakis MD, PhD , Amie W. Hsia MD , John K. Lynch DO, MPH , Karan P. Nathani MD , Sana Somani MD , Leila C. Thomas BSN, MPH , Fabian Arnberg-Sandor MD, PhD , Lawrence L. Latour PhD

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引用次数: 0

Abstract

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.

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动脉自旋标记充血检测与脑卒中血管内治疗后的最终梗死体积相关

背景和目的急性缺血性卒中（AIS）患者接受血管内治疗（EVT）可能会由于相对脑血流（rCBF）自动调节的丧失而发生充血。两种MRI灌注加权成像：动态敏感性对比（DSC）和动脉自旋标记（ASL）可以检测到充血。本研究的目的是比较evt后ASL-rCBF和DSC-rCBF的充血，并探讨充血与最终梗死体积（FIV）之间的关系。方法：对正在进行的前瞻性卒中自然史研究（ClinicalTrials.gov识别符：NCT00009243）中的卫兵队列进行回顾性分析。符合以下标准的AIS患者符合本分析的条件：(i)≥18岁，（ii）无3T MRI禁忌症，（iii）前循环大血管闭塞，（iv）尝试EVT， (v) EVT后24小时3T MRI，包括DSC-rCBF和ASL-rCBF， EVT后5天。定性成像分析充血检测是由两个独立的评判员达成共识。定量成像分析评估充血组织体积、FIV以及充血和FIV口罩之间的Dice系数。结果入选患者40例，中位（IQR）年龄70（62 ~ 81）岁，入院NIHSS 16（10 ~ 21）。40%（16）的患者在ASL-rCBF上发现充血，30%（12）的患者在DSC-rCBF上发现充血。在9例两种方式均充血的患者中，ASL-rCBF和DSC-rCBF的中位容量分别为85.7（19.4-144.9）和58.1 (26.2-74.0)（p = 0.10）。ASL-rCBF和FIV充血的Dice系数高于DSC-rCBF，分别为0.60（0.54-0.69）和0.39（0.34-0.49）。结论与DSC-rCBF相比，ASL-rCBF在24小时测量的充血体积与第5天的FIV更相关。充血可能是大脑自身调节功能受损的一个指标，也是缓解梗死生长的辅助治疗的潜在目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.