在双能 CT 中进行多物质分解以确定急性缺血性中风患者血栓的特征

IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Melina Gassenhuber, Maximilian E. Lochschmidt, Johannes Hammel, Tobias Boeckh-Behrens, Benno Ikenberg, Silke Wunderlich, Friederike Liesche-Starnecker, Jürgen Schlegel, Franz Pfeiffer, Marcus R. Makowski, Claus Zimmer, Isabelle Riederer, Daniela Pfeiffer
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引用次数: 0

摘要

背景目前还没有一种方法能在干预前定量描述急性缺血性中风血栓的物质组成,但双能 CT(DE-CT)提供了基于成像的多物质分解。我们以组织学分析为参考,使用 DE-CT 回顾性地研究了活体血栓的物质组成。方法通过机械血栓切除术提取 70 例急性缺血性中风患者的血栓,并使用 DE-CT 在福尔马林填充管中进行活体扫描。对红细胞(RBC)、白细胞(WBC)和纤维蛋白/血小板(F/P)三种成分进行多物质分解,并与组织学(苏木精/伊红染色)作为参考进行比较。结果组织学和成像分析显示,RBC(r = 0.527,p < 0.001)、WBC(r = 0.305,p = 0.020)和 F/P (r = 0.525,p < 0.001)的相关系数如下。与富含 F/P 的血栓相比,富含 RBC 的血栓在 Hounsfield 单位上的血块衰减更高(51 HU 对 42 HU,p <0.01)。在组织学分析中,心肌栓塞血栓显示较少的 RBC(40% 对 56%,p = 0.053)和较多的 F/P(53% 对 36%,p = 0.024),这与隐源性血栓类似,与非心肌栓塞卒中相比,隐源性血栓显示较少的 RBC(34% 对 56%,p = 0.006)和较多的 F/P(58% 对 36%,p = 0.003)。结论DE-CT具有定量描述缺血性中风血栓物质组成的潜力。相关声明使用DE-CT可以确定缺血性中风血栓的组成。在介入治疗前了解组织学成分可为每位患者制定个性化的治疗策略,以实现更快的再通和更好的临床疗效。- 目前,还没有一种方法可以在介入治疗前确定血栓的组成。- DE-CT 可以定量分解血栓在体内红细胞、白细胞和纤维蛋白/血小板中的物质。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multimaterial decomposition in dual-energy CT for characterization of clots from acute ischemic stroke patients

Background

Nowadays, there is no method to quantitatively characterize the material composition of acute ischemic stroke thrombi prior to intervention, but dual-energy CT (DE-CT) offers imaging-based multimaterial decomposition. We retrospectively investigated the material composition of thrombi ex vivo using DE-CT with histological analysis as a reference.

Methods

Clots of 70 patients with acute ischemic stroke were extracted by mechanical thrombectomy and scanned ex vivo in formalin-filled tubes with DE-CT. Multimaterial decomposition in the three components, i.e., red blood cells (RBC), white blood cells (WBC), and fibrin/platelets (F/P), was performed and compared to histology (hematoxylin/eosin staining) as reference. Attenuation and effective Z values were assessed, and histological composition was compared to stroke etiology according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria.

Results

Histological and imaging analysis showed the following correlation coefficients for RBC (r = 0.527, p < 0.001), WBC (r = 0.305, p = 0.020), and F/P (r = 0.525, p < 0.001). RBC-rich thrombi presented higher clot attenuation in Hounsfield units than F/P-rich thrombi (51 HU versus 42 HU, p < 0.01). In histological analysis, cardioembolic clots showed less RBC (40% versus 56%, p = 0.053) and more F/P (53% versus 36%, p = 0.024), similar to cryptogenic clots containing less RBC (34% versus 56%, p = 0.006) and more F/P (58% versus 36%, p = 0.003) than non-cardioembolic strokes. No difference was assessed for the mean WBC portions in all TOAST groups.

Conclusions

DE-CT has the potential to quantitatively characterize the material composition of ischemic stroke thrombi.

Relevance statement

Using DE-CT, the composition of ischemic stroke thrombi can be determined. Knowledge of histological composition prior to intervention offers the opportunity to define personalized treatment strategies for each patient to accomplish faster recanalization and better clinical outcomes.

Key points

• Acute ischemic stroke clots present different recanalization success according to histological composition.

• Currently, no method can determine clot composition prior to intervention.

• DE-CT allows quantitative material decomposition of thrombi ex vivo in red blood cells, white blood cells, and fibrin/platelets.

• Histological clot composition differs between stroke etiology.

• Insights into the histological composition in situ offer personalized treatment strategies.

Graphical Abstract

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来源期刊
European Radiology Experimental
European Radiology Experimental Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
6.70
自引率
2.60%
发文量
56
审稿时长
18 weeks
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