{"title":"低表观扩散系数值与血管内治疗大缺血核心后出血转化有关。","authors":"Takeru Umemura, Yuko Tanaka, Toru Kurokawa, Ryo Miyaoka, Masaru Idei, Hirotsugu Ohta, Junkoh Yamamoto","doi":"10.1007/s00234-025-03682-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular treatment (EVT) for large ischemic stroke is associated with a risk of hemorrhagic transformation (HT). The severity of ischemic stress can be assessed using the apparent diffusion coefficient (ADC), with a high ADC indicating viability. This study aimed to examine whether a low ADC is associated with HT following EVT, based on a low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and diffusion-weighted imaging (DWI).</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with acute large ischemic stroke (ASPECTS-DWI ≤ 5) who underwent EVT with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) in the ischemic core and DWI lesion volume were assessed. Patients with and without HT following EVT were compared to evaluate the associated between a low ADC and HT.</p><p><strong>Results: </strong>Seventy-eight patients were enrolled, 25 (32%) of whom experienced HT after EVT. Parenchymal hematomas were observed in 17 patients (22%). Statistically significant differences in peak ADC and onset-to-recanalization time were observed between patients with and without HT (p = 0.0036 and p = 0.0151, respectively). In multivariate analysis, a low peak ADC was associated with HT (odds ratio [OR], 0.839; p = 0.018), but onset-to-recanalization time was not. A threshold peak ADC resulting in HT was calculated as < 480 × 10<sup>-6</sup> mm<sup>2</sup>/s.</p><p><strong>Conclusions: </strong>A low peak ADC was associated with HT after EVT for a large ischemic core. The threshold of the peak ADC that resulted in HT was < 480 × 10<sup>-6</sup> mm<sup>2</sup>/s. These results suggest that evaluating the ischemic core is necessary to confirm EVT.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"2497-2504"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A low apparent diffusion coefficient value is associated with hemorrhagic transformation following endovascular treatment for a large ischemic core.\",\"authors\":\"Takeru Umemura, Yuko Tanaka, Toru Kurokawa, Ryo Miyaoka, Masaru Idei, Hirotsugu Ohta, Junkoh Yamamoto\",\"doi\":\"10.1007/s00234-025-03682-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Endovascular treatment (EVT) for large ischemic stroke is associated with a risk of hemorrhagic transformation (HT). The severity of ischemic stress can be assessed using the apparent diffusion coefficient (ADC), with a high ADC indicating viability. This study aimed to examine whether a low ADC is associated with HT following EVT, based on a low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and diffusion-weighted imaging (DWI).</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with acute large ischemic stroke (ASPECTS-DWI ≤ 5) who underwent EVT with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) in the ischemic core and DWI lesion volume were assessed. Patients with and without HT following EVT were compared to evaluate the associated between a low ADC and HT.</p><p><strong>Results: </strong>Seventy-eight patients were enrolled, 25 (32%) of whom experienced HT after EVT. Parenchymal hematomas were observed in 17 patients (22%). Statistically significant differences in peak ADC and onset-to-recanalization time were observed between patients with and without HT (p = 0.0036 and p = 0.0151, respectively). In multivariate analysis, a low peak ADC was associated with HT (odds ratio [OR], 0.839; p = 0.018), but onset-to-recanalization time was not. A threshold peak ADC resulting in HT was calculated as < 480 × 10<sup>-6</sup> mm<sup>2</sup>/s.</p><p><strong>Conclusions: </strong>A low peak ADC was associated with HT after EVT for a large ischemic core. The threshold of the peak ADC that resulted in HT was < 480 × 10<sup>-6</sup> mm<sup>2</sup>/s. These results suggest that evaluating the ischemic core is necessary to confirm EVT.</p>\",\"PeriodicalId\":19422,\"journal\":{\"name\":\"Neuroradiology\",\"volume\":\" \",\"pages\":\"2497-2504\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuroradiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00234-025-03682-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00234-025-03682-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/18 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
A low apparent diffusion coefficient value is associated with hemorrhagic transformation following endovascular treatment for a large ischemic core.
Purpose: Endovascular treatment (EVT) for large ischemic stroke is associated with a risk of hemorrhagic transformation (HT). The severity of ischemic stress can be assessed using the apparent diffusion coefficient (ADC), with a high ADC indicating viability. This study aimed to examine whether a low ADC is associated with HT following EVT, based on a low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and diffusion-weighted imaging (DWI).
Methods: This retrospective cohort study included consecutive patients with acute large ischemic stroke (ASPECTS-DWI ≤ 5) who underwent EVT with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) in the ischemic core and DWI lesion volume were assessed. Patients with and without HT following EVT were compared to evaluate the associated between a low ADC and HT.
Results: Seventy-eight patients were enrolled, 25 (32%) of whom experienced HT after EVT. Parenchymal hematomas were observed in 17 patients (22%). Statistically significant differences in peak ADC and onset-to-recanalization time were observed between patients with and without HT (p = 0.0036 and p = 0.0151, respectively). In multivariate analysis, a low peak ADC was associated with HT (odds ratio [OR], 0.839; p = 0.018), but onset-to-recanalization time was not. A threshold peak ADC resulting in HT was calculated as < 480 × 10-6 mm2/s.
Conclusions: A low peak ADC was associated with HT after EVT for a large ischemic core. The threshold of the peak ADC that resulted in HT was < 480 × 10-6 mm2/s. These results suggest that evaluating the ischemic core is necessary to confirm EVT.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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