基于酰胺质子转移加权成像、DWI不匹配评估醒后脑卒中患者缺血半暗带的可行性研究

Evaluation of ischemic penumbra in wake-up stroke patients based on mismatch of amide-proton transfer weighted imaging with DWI:a feasibility study

目的探讨根据酰胺质子转移加权(APTw)成像、弥散加权成像(DWI)不匹配评估醒后脑卒中患者缺血半暗带(IP)的可行性。方法前瞻性纳入济宁医学院附属医院急诊卒中科自2020年9月至2023年1月收治的96例单侧大脑中动脉供血区梗死的醒后脑卒中患者。所有患者治疗前、治疗后90 d均行常规MRI、DWI、APTw及三维动脉自旋标记(3D-ASL)检查。将治疗后90 d复查T2-液体衰减反转恢复序列(FLAIR)所示异常信号范围较治疗前DWI所示高信号范围改变大于20%定义为真实存在IP,以此作为金标准,分别计算治疗前基于3D-ASL、DWI与APTw、DWI不匹配判断患者存在IP的效能。在基于3D-ASL、DWI不匹配与APTw、DWI不匹配判断均存在IP的患者融合图像上勾画梗死核心区,APTw、DWI不匹配区,3D-ASL、APTw不匹配区,比较不同区域APTw值的差异。结果根据复查结果,50例患者真实存在IP,46例不存在IP。根据治疗前3D-ASL、DWI不匹配判断患者存在IP的特异性、准确性、敏感性分别为86.9%、93.7%、100.0%;根据治疗前APTw、DWI不匹配判断患者存在IP的特异性、准确性、敏感性分别为100.0%、95.8%、92.0%。患者梗死核心区APTw最大值(APTwmax)、APTw最小值(APTwmin)、APTw平均值(APTwave)均低于APTw、DWI不匹配区,APTw、DWI不匹配区APTw最大值和最小值的差值(APTwmax-min)高于3D-ASL、APTw不匹配区,差异均有统计学意义(P<0.05)。结论APTw可以反映醒后脑卒中患者不同脑区酸中毒状态,且根据治疗前APTw、DWI不匹配评估醒后脑卒中患者存在IP的特异性和准确性高于根据3D-ASL、DWI不匹配评估。

Objective To explore the feasibility of mismatch of amide proton transfer weighted(APTw)imaging with diffusion weighted imaging(DWI)in evaluating ischemic penumbra(IP)in patients with wake-up stroke.Methods A prospective study was performed;96 patients with wake-up stroke and unilateral middle cerebral artery territory infarction admitted to Emergency Stroke Department,Affiliated Hospital of Jining Medical University from September 2020 to January 2023 were chosen.All patients underwent routine MRI,DWI,APTw imaging and 3D arterial spin labeling(3D-ASL)before treatment and 90 d after treatment.IP presence was defined as changes of abnormal signal on T2-fluid-attenuated inversion recovery(FLAIR)90 d after treatment greater than 20%of high signal range on DWI before treatment,and it was used as the gold standard to compare the efficacy in evaluating whether the patients had IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw imaging with DWI before treatment.The infarct core(IC)region,mismatch region of APTw imaging with DWI,mismatch region of 3D-ASL with APTw imaging were delineated on the fusion images in patients with IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw with DWI,and the differences of APTw values in different regions were compared.Results According to the 90-d follow-up results,50 patients had IP and 46 patients did not have IP.Specificity,accuracy and sensitivity evaluating whether the patients had IP based on mismatch of 3D-ASL with DWI were 86.9%,93.7%and 100.0%,respectively;specificity,accuracy and sensitivity evaluating whether the patients had IP based on mismatch of APTw imaging with DWI were 100.0%,95.8%and 92.0%,respectively.The APTwmax,APTwmin and APTwave values of the IC region were significantly lower than those of mismatch region of APTw with DWI,and the APTwmax-min values of mismatch region of APTw imaging with DWI were significantly higher than those of mismatch region of 3D-ASL with APTw imaging(P<0.05).Conclusion APTw imaging can reflect the acidosis status of different brain regions in patients with wake-up stroke;specificity and accuracy evaluating whether the patients have IP based on mismatch of APTw imaging with DWI are higher than those based on mismatch of 3D-ASL with DWI.