磁共振血管成像-弥散成像不匹配对预测急性缺血性脑卒中缺血半暗带的价值

Value of magnetic resonance angiography-diffusion mismatch to predict the ischemic penumbra in acute ischemic stroke

目的研究急性缺血性脑卒中(AIS)超早期磁共振血管成像(MRA)-弥散成像(DWI)不匹配对预测缺血半暗带的价值。方法选择在发病6h内完成MRA、DWI及灌注成像(PWI)检查的大脑中动脉供血区脑梗死患者,MRA-DWI梗死体积不匹配定义为MRA示大脑中动脉M1段闭塞,DWI的梗死体积<25ml;MRA-DWI梗死部位不匹配定义为M1段闭塞,DWI的梗死部位评分(以Alberta梗死早期CT评分评价)≥7。结果共入选78例患者,MRA-DWI梗死体积不匹配预测:PWI-DWI不匹配的特异度为100%,灵敏度仅为46%。MRA-DWI梗死部位不匹配预测:PWI-DWI不匹配的特异度为100%,灵敏度为42.9%。结论AIS超早期MRA-DWI不匹配预测缺血半暗带有很高的特异度,可作为筛选进行溶栓治疗患者的手段。

Objective To evaluate the value of magnetic resonance angiography-diffusion mismatch to predict the ischemic penumbra in acute ischemic stroke, Methods Patients with acute cerebral infarcts within the middle cerebral artery territory and imaged within 6 hours after symptom onset were prospectively studied. MRI including MRA, DWI and PWI sequences were performed on admission. We defined MRA-DWI Volume mismatch as MCA （M1） occlusion and DWI lesion volume ≤ 25 ml. MRA-DWI ASPECTS mismatch was defined as MCA （M1） occlusion and Alberta Stroke Program Early CT Score of DWI ≥7. DWI lesion and PWI （ MTT ） volumes were measured by planimetric techniques. PWI-DWI mismatch was examined as a categorical variable （ mismatch = PWI - DWI/DWI × 100% ≥20% ）. Results 78 patients met inclusion criterion, MRA-DWI Volume mismatch detected PWI-DWI mismatch with a specificity of 100%, but a sensitivity of only 46%. MRA-DWI ASPECTS mismatch detected PWI-DWI mismatch still with a high specificity of 100% and a low sensitivity of only 42.9%. Conclusions MRA-DWIVolume mismatch and MRA-DWI ASPECTS mismatch predict the presence of PWI-DWI mismatch with high specificity and low sensitivity. They may be useful to select patient candidates for thrombolysis.