急性缺血性脑卒中局部VLCBV与DWI及ADC在预测出血转化中的对比研究

Predicted value of regional VLCBV,DWI volume and thresholded ADC in hemorrhagic transformation of acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)局部极低脑血容量(VLCBV)与DWI及阈值表观扩散系数(ADC)在预测出血转化(hemorrhagic transformation,HT)中的价值。方法从无脑卒中侧大脑半球计算正常百分位数CBV值,并确定CBV阈值的0、2.5、5和10百分位数。另外,在急性缺血性脑卒中DWI缺血病灶中计算VLCBV的病灶组织体积;对两种方法预测HT效果进行比较。结果 100例患者中排除10例不符合标准,有42例发生HT。在42例HT患者中有12例(4例有症状)发生脑实质出血(Parenchymal hematoma,PH),30例发生无症状性出血性梗死(hemorrhagic infarction,HI)。VLCBV的中位体积在PH的病例中显著增高。受试者工作曲线(ROC)显示,用VLCBV预测HT优于DWI和ADC;Logical回归分析显示,VLCBV是HT发生的独立危险因素。根据VLCBV对5例急性缺血性脑卒中患者进行溶栓,显示其HT发生率较以往显著降低(P<0.05)。结论 VLCBV与DWI或ADC相比对溶栓后是否发生HT具有更好的预测价值,尤其是在DWI体积较小的缺血性脑卒中患者中优势最为明显,依据VLCBV值进行溶栓可有效降低HT的发生率。

Objective To investigate the predicted value of regional VLCBV,DWI Volume and Thresholded ADC in Hemorrhagic Transformation of acute ischemic stroke.Methods The normal percentile CBV values were calculated from the cerebral hemisphere without stroke and the 0,2.5,5,and 10 percentiles of the CBV threshold were determined.In addition,the lesion tissue volume of VLCBV was calculated in acute DWI ischemic lesions.The HT prediction effects of the two methods were compared.Results Of the 100 patients,10 were excluded from the standard and 42 were HT.Of the 42 patients with HT,12(4 with symptoms)had parenchymal hematoma(PH)and30 had hemorrhagic infarction(HI).The median volume of VLCBV was significantly increased in the case of PH.The receiver operating curve(ROC)showed that The HT prediction effect of VLCBV preceded that of DWI and ADC.Logical regression analysis showed that VLCBV was an independent risk factor for HT.According to VLCBV,50 patients with acute ischemic stroke were thrombolysis,which showed that the incidence of HT was significantly lower than that of before the thrombolysis(P<0.05).Conclusion Compared with DWI or ADC,VLCBV had better predictive value for HT after thrombolysis,especially in recurrence patients with small DWI lesions.Thrombolysis based on VLCBV could effectively reduce the incidence of HT.