pCASL图对急性缺血性卒中终末核的预测价值:一项观察性单中心研究。

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Fabrizio Giammello, Agostino Tessitore, Francesco Grillo, Cristina Dell'Aera, Ludovica Ferraù, Valentina Tudisco, Antonio Ciacciarelli, Davide Vicari, Valeria Garufi, Sergio Lucio Vinci, Sara Rosa Maria Martino, Luigi Simonetti, Michele Romoli, Rosa Fortunata Musolino, Mauro Silvestrini, Danilo Toni, Andrea Zini, Antonio Toscano
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引用次数: 0

摘要

目的:急性缺血性脑卒中(AIS)的三室室模型包括非活组织(NVT)、危险组织(TAR)和良性少血。在评估了基于多模态计算机断层扫描(CT)的方案后,我们评估了基于磁共振成像(MRI)的超急性卒中成像方案,旨在更好地表征这两种方法预测后续梗死的可靠性。方法:我们回顾性地回顾了627例连续的AIS患者,评估了在综合卒中中心进行再灌注治疗的选择。我们采用基于mri的方案来选择合适的患者,包括假连续动脉自旋标记(pCASL)和弥散加权成像(DWI)。为了评估pCASL图预测最终梗死的准确性,我们假设在具有良好临床-放射预后的患者中,NVT与最终梗死之间存在最佳相关性。另一方面,TAR应更好地与未治疗患者的最终梗死和治疗失败相关。结果:我们招募了349例患者,采用基于mri的DWI和pCASL诊断方案,诊断准确率为84.8%。在前循环灌注不足的患者中,DWI对NVT的诊断是高度可靠的,具有良好的临床-器械预后。对于预后不良的患者,PCASL倾向于高估TAR,但与最终梗死完全重叠的比率很高。先前评估的基于ct的方案显示出较低的预后准确性,因为使用最大时间的ct灌注高估了NVT和TAR。结论:我们发现DWI-pCASL具有高度可靠的预后准确性。即使pCASL被证明可以可靠地识别全灌注不足的区域,但在许多情况下,对TAR的估计过高,并倾向于纳入良性低血凝。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictor value of pCASL maps on final core in acute ischemic stroke: an observational single‑center study.

Purpose: The three-compartment model of acute ischemic stroke (AIS) includes non-viable tissue (NVT), tissue at risk (TAR), and benign oligoemia. After assessing a multimodal computed tomography (CT)-based protocol, we assessed a hyperacute stroke imaging protocol with magnetic resonance imaging (MRI), aiming to better characterize the reliability of the two methods in predicting follow-up infarction.

Methods: We retrospectively reviewed 627 consecutive AIS patients evaluated for the selection for reperfusive treatments at comprehensive stroke center. We employed an MRI-based protocol for proper patient selection, including pseudocontinuous arterial spin labeling (pCASL) and diffusion-weighted imaging (DWI). To assess prognostic accuracy of pCASL maps in predicting final infact, we assumed the best correlation between NVT and final infarct in patients with favorable clinico-radiological outcomes. On the other hand, the TAR should better correlate with final infarct in untreated patients and in treatment failure.

Results: We recruited 349 patients undergoing MRI-based protocol with DWI and pCASL, showing diagnostic accuracy of 84.8%. In anterior circulation perfusion deficit, DWI was highly reliable for NVT in patients with favorable clinical-instrumental outcomes. PCASL tended to overestimate TAR in patients with unfavorable outcome, but the rate of complete overlap with the final infarct was high. The previously assessed CT-based protocol showed a lower prognostic accuracy, as the CT-perfusion using time-to-maximum overestimated both the NVT and the TAR.

Conclusions: We found a highly reliable prognostic accuracy for DWI-pCASL. Even if pCASL proved reliable to identify the area of total hypoperfusion, there was an overestimation of TAR in many cases, with a tendency to incorporate the benign oligoemia.

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来源期刊
Neuroradiology
Neuroradiology 医学-核医学
CiteScore
5.30
自引率
3.60%
发文量
214
审稿时长
4-8 weeks
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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