基于动脉自旋标记与弥散加权成像的ASPECTS评分不匹配可以指导醒后卒中患者的机械取栓治疗（英文）

Mismatch of ASPECTS based on arterial spin labeling and diffusion-weighted imaging as an indicator for mechanical thrombectomy in patients with wake-up stroke

目的快速可靠地评估弥散加权成像(DWI)和动脉自旋标记(ASL)的不匹配对于临床取栓决策至关重要。醒后卒中患者中仅有极少数可进行取栓治疗,本研究回顾性地分析了大血管闭塞的醒后卒中患者的预后,依据入院磁共振ASL及DWI序列ASPECTS不匹配选择患者进行干预。方法回顾性分析连续12例前循环大动脉闭塞性醒后卒中患者,接受治疗前均进行了磁共振(ASL与DWI)检查。不匹配ASPECTS定义为ASL-ASPECTS与DWI-ASPECTS的差异(分数越高,差别越大)。结果所有患者取栓治疗后均成功再灌注(脑梗死溶栓分级TICI 2b-3)。11名(91.7%)患者出院时国立卫生研究院卒中量表(NIHSS)评分显著降低,8名(66.7%)患者90 d改良Rankin量表(m RS)评分≤2分。结论基于ASL和DWI的ASPECTS不匹配可用于快速筛选患者,指导动脉取栓治疗。

Objective To retrospectively analyze the outcomes of wake-up stroke(WUS)patients with occlusion of large vessel occlusion(LVO),who were selected for mechanical thrombectomy according to the mismatch of Alberta Stroke Program Early CT Score(ASPECTS)based on arterial spin labeling(ASL)and diffusion-weighted image(DWI)on admission magnetic resonance(MR)scans.Methods Twelve consecutive WUS patients with acute LVO of the anterior circulation undergoing MR scans with ASL and DWI prior to thrombectomy were retrospectively evaluated.The mismatch of ASPECTS was defined as the difference between ASL-ASPECTS and DWI-ASPECTS,and a higher score indicates a greater mismatch.Results The procedures led to successful reperfusion in all the cases(Thrombolysis in Cerebral Infarction Grade 2 b-3).Eleven patients(91.7%)had significantly decreased National Institute of Health Stroke scale(NIHSS)score at discharge.A mRS score of≤2 at 90 days was achieved in 8 of the 12 patients(66.7%).Conclusion The mismatch between ASPECTS assessed based on ASL and DWI can detect a true mismatch in patients with acute LVO of the anterior circulation,and can be used for rapid screening of patients eligible for thrombectomy.