重新定义基于 CT 灌注的缺血核心估计值,用于早期时间窗中风的幽灵核心。

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY
Manisha Koneru, Meisam Hoseinyazdi, Dhairya A. Lakhani, Cynthia Greene, Karen Copeland, Richard Wang, Risheng Xu, Licia Luna, Justin M. Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy J. Heit, Gregory W. Albers, Max Wintermark, Luis F. Gonzalez, Victor C. Urrutia, Judy Huang, Kambiz Nael, Richard Leigh, Elisabeth B. Marsh, Argye E. Hillis, Rafael H. Llinas, Vivek S. Yedavalli
{"title":"重新定义基于 CT 灌注的缺血核心估计值,用于早期时间窗中风的幽灵核心。","authors":"Manisha Koneru,&nbsp;Meisam Hoseinyazdi,&nbsp;Dhairya A. Lakhani,&nbsp;Cynthia Greene,&nbsp;Karen Copeland,&nbsp;Richard Wang,&nbsp;Risheng Xu,&nbsp;Licia Luna,&nbsp;Justin M. Caplan,&nbsp;Adam A. Dmytriw,&nbsp;Adrien Guenego,&nbsp;Jeremy J. Heit,&nbsp;Gregory W. Albers,&nbsp;Max Wintermark,&nbsp;Luis F. Gonzalez,&nbsp;Victor C. Urrutia,&nbsp;Judy Huang,&nbsp;Kambiz Nael,&nbsp;Richard Leigh,&nbsp;Elisabeth B. Marsh,&nbsp;Argye E. Hillis,&nbsp;Rafael H. Llinas,&nbsp;Vivek S. Yedavalli","doi":"10.1111/jon.13180","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Purpose</h3>\n \n <p>In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)&lt;30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to <i>p</i>-value ≤.05.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF&lt;30%, rCBF&lt;34%, and rCBF&lt;38% volumes were significantly, inversely correlated with percentage NIHSS change (<i>p</i>&lt;.048). No other parameters significantly correlated with outcomes.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.</p>\n </section>\n </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"249-256"},"PeriodicalIF":2.3000,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Redefining CT perfusion-based ischemic core estimates for the ghost core in early time window stroke\",\"authors\":\"Manisha Koneru,&nbsp;Meisam Hoseinyazdi,&nbsp;Dhairya A. Lakhani,&nbsp;Cynthia Greene,&nbsp;Karen Copeland,&nbsp;Richard Wang,&nbsp;Risheng Xu,&nbsp;Licia Luna,&nbsp;Justin M. Caplan,&nbsp;Adam A. Dmytriw,&nbsp;Adrien Guenego,&nbsp;Jeremy J. Heit,&nbsp;Gregory W. Albers,&nbsp;Max Wintermark,&nbsp;Luis F. Gonzalez,&nbsp;Victor C. Urrutia,&nbsp;Judy Huang,&nbsp;Kambiz Nael,&nbsp;Richard Leigh,&nbsp;Elisabeth B. Marsh,&nbsp;Argye E. Hillis,&nbsp;Rafael H. Llinas,&nbsp;Vivek S. Yedavalli\",\"doi\":\"10.1111/jon.13180\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Purpose</h3>\\n \\n <p>In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)&lt;30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to <i>p</i>-value ≤.05.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF&lt;30%, rCBF&lt;34%, and rCBF&lt;38% volumes were significantly, inversely correlated with percentage NIHSS change (<i>p</i>&lt;.048). No other parameters significantly correlated with outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.</p>\\n </section>\\n </div>\",\"PeriodicalId\":16399,\"journal\":{\"name\":\"Journal of Neuroimaging\",\"volume\":\"34 2\",\"pages\":\"249-256\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2023-12-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuroimaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jon.13180\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuroimaging","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jon.13180","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景和目的:在大血管闭塞(LVO)卒中患者中,相对脑血流(rCBF)方法:分析来自两个前瞻性登记中心的患者。纳入的患者均患有 LVO,在最后一次已知良好后 3 小时内发病,并成功进行了再灌注。主要短期神经功能结果是美国国立卫生研究院卒中量表(NIHSS)从入院到出院的百分比变化。次要长期结果是 90 天修改后的 Rankin 评分。进行了斯皮尔曼相关性分析。P值⩽.05为显著性:73名患者的中位年龄为66岁(四分位数间距为54-76岁)。在所有治疗前影像学参数中,rCBFConclusions:我们的多点分析表明,良好的短期神经功能恢复与早期时间窗中的 rCBF 量显著相关。然而,适度的相关性为一般缺血核心估计阈值在该亚群中的适用性有限提供了支持性证据。我们的研究结果支持未来更大规模地放宽或重新评估目前指导早期时间窗卒中患者治疗决策的 rCBF 参数阈值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Redefining CT perfusion-based ischemic core estimates for the ghost core in early time window stroke

Background and Purpose

In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.

Methods

Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to p-value ≤.05.

Results

Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (p<.048). No other parameters significantly correlated with outcomes.

Conclusions

Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Neuroimaging
Journal of Neuroimaging 医学-核医学
CiteScore
4.70
自引率
0.00%
发文量
117
审稿时长
6-12 weeks
期刊介绍: Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信