磁敏感加權(quán)成像靜脈不對稱性在急性缺血性腦卒中靜脈溶栓中的應(yīng)用
發(fā)布時間：2018-08-26 13:06
【摘要】：研究背景 缺血性卒中是我國卒中的主要亞型,約占80%。重組組織型纖溶酶原激活劑(recombinant tissue plasminogen activator, rtPA)溶栓治療是目前臨床指南推薦的有效的缺血性卒中急性期治療之一。溶栓的目標(biāo)是恢復(fù)缺血組織的灌注,那些因為處于缺血狀態(tài)而失去功能,但尚未器質(zhì)性死亡的神經(jīng)細(xì)胞可以在血運重建后獲得拯救,這些“功能受損但無器質(zhì)性死亡”的組織即可被挽救的半暗帶組織。 目前臨床上可使用影像技術(shù)來反映卒中的生理病理變化過程,研究較多的主要是正電子發(fā)射斷層顯像(Positron Emission Tomography, PET)及核磁共振成像(Magnetic Resonance Imaging, MRI).PET是目前臨床上用來評估半暗帶的金標(biāo)準(zhǔn),它使用各種代謝參數(shù)和配體成像技術(shù)來評估半暗帶和核心梗死組織,但PET在臨床無法普及。MRI利用灌注加權(quán)成像(Perfusion-Weighted Imaging, PWI)序列和彌散加權(quán)成像(Diffusion-Weighted Imaging, DWI)序列病灶的差異來表示半暗帶,但PWI定義的灌注缺損尚缺乏一個良好驗證且廣泛認(rèn)可的閾值。 近來,基于血氧水平依賴(BOLD)成像原理的磁敏感加權(quán)成像(Susceptibility-Weighted Imaging, SWI)引起研究者的興趣。磁敏感成像對血管內(nèi)脫氧血紅蛋白(deoxygenated hemoglobin, DHB)敏感,而缺血組織的DHB與正常組織的DHB含量有差異,因而可作為間接反映組織氧代謝的指標(biāo)。本文旨在研究SWI上腦靜脈異常低信號在急性腦梗死靜脈溶栓中的應(yīng)用及機(jī)制。 第一部分磁敏感加權(quán)成像靜脈不對稱性程度與灌注缺損相關(guān) 目的：假設(shè)磁共振磁敏感成像(Susceptibility-Weighted Imaging, SWI)(3.0T)上靜脈低信號不對稱性可以反映缺血性腦卒中灌注缺損體積大小。 方法：我們對前瞻性登記的靜脈溶栓數(shù)據(jù)庫進(jìn)行回顧,納入靜脈溶栓前行多模式MRI檢查的前循環(huán)腦梗死患者。灌注缺損體積定義為Tmax6s的體積,靜脈不對稱指數(shù)(Asymmetry index, AI)定義為梗死側(cè)與正常側(cè)腦靜脈像素和之比。溶栓前后深部靜脈AI的絕對變化(AAI)定義為基線AI與24小時AI之差,相對變化(r△AI)定義為基線AI與24小時AI之比。我們使用ASPECTS評分和AI測量法兩種不同的評估靜脈不對稱的方法,分別按數(shù)值大小分為兩組,然后比較不同組之間的基線參數(shù)和預(yù)后參數(shù)。并進(jìn)一步用非參數(shù)檢驗比較了靜脈不對稱性在溶栓后的變化。 結(jié)果：低ASPECTS組相較于高ASPECTS組,TIMI (thrombosis in myocardial infarction flow grading)分級更低(I士1vs2±1,P0.001),灌注缺損體積更大(105±62vs57±89ml, P=0.015),灌注缺損體積更大(104±62ml vs60±87ml, P=0.025).相較于低AI組,高AI組有更低的TIMI評分(1(IQR:0-1) vs2(IQR:0-3), P=0.002),更大的低灌注體積(120±83ml vs58±67ml, P=0.004).再通患者較無再通患者AI變化更大(△AI:1.20vs0.11, P0.001; r△AI:3.54vs1.11, P0.001);再灌注患者較無再灌患者AI變化亦更大(△AI:0.93vs0.12, P=0.031; rAAI:2.06vs1.17, P=0.029)。 結(jié)論：SWI靜脈不對稱可反映急性缺血性腦卒中患者的灌注缺損體積,靜脈不對稱性低信號可在血流再灌注后逆轉(zhuǎn)。 第二部分SWI-DWI不匹配對靜脈溶栓療效的預(yù)測作用 背景和方法：磁敏感加權(quán)成像(susceptibility-weighted imaging, SWI)上的腦靜脈不對稱性可間接反映腦組織缺氧情況。因而我們在本研究中探討SWI上靜脈不對稱明顯而彌散加權(quán)成像(diffusion-weighted imaging, DWI)上病灶較小的SWI-DWI不匹配,是否能預(yù)測靜脈溶栓療效。 方法：我們對前瞻性登記的靜脈溶栓數(shù)據(jù)庫進(jìn)行回顧,納入靜脈溶栓前行多模式MRI檢查的前循環(huán)腦梗死患者。靜脈不對稱指數(shù)(Asymmetry index, AI)定義為梗死側(cè)與正常側(cè)腦靜脈像素和之比,SWI-DWI不匹配定義為AI≥1.75但DWI病灶體積≤25ml。良好結(jié)局為3月改良Rankin評分(modified Rankin Scale, mRS)0-2分,單因素和多因素分析SWI-DWI不匹配是否為良好預(yù)后的獨立影響因子。 結(jié)果：納入54例患者,存在SWI-DWI不匹配的患者較無SWI-DWI不匹配的患者良好預(yù)后的比例更高(78%vs44%；OR=6.317；95%CI：1.12-35.80,P=0.037)。存在SWI-DWI不匹配的患者更能從再灌注(91%vs43%,p=-0.033)、再通(100%vs40%,P=0.013)中獲得良好預(yù)后。SWI-DWI不匹配預(yù)測良好預(yù)后的準(zhǔn)確度較灌注加權(quán)成像-彌散加權(quán)成像不匹配高(63%vs48.1%)。 結(jié)論：SWI-DWI不匹配可預(yù)測靜脈溶栓療效,可能用于篩選靜脈溶栓獲益患者。
[Abstract]:Research background
Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is one of the effective therapies recommended by clinical guidelines for acute ischemic stroke. The goal of thrombolysis is to restore the perfusion of ischemic tissue, which is due to ischemia. Neurons that are in a state of disfunction but not yet organically dead can be rescued after revascularization, and these "functionally impaired but non-organically dead" tissues can be rescued in the penumbra.
At present, imaging technology can be used to reflect the physiological and pathological changes of stroke. Positron emission tomography (PET) and magnetic resonance imaging (MRI) are the main research methods. PET is the gold standard used to evaluate the penumbra in clinic. It uses various metabolic parameters. Number and ligand imaging techniques are used to assess the penumbra and core infarct tissues, but PET is not widely used in clinic. MRI uses the difference of lesions between Perfusion-Weighted Imaging (PWI) and Diffusion-Weighted Imaging (DWI) sequences to represent the penumbra, but the perfusion defect defined by PWI lacks a good one. Well validated and widely recognized threshold.
Recently, magnetic susceptibility-weighted imaging (SWI) based on the principle of blood oxygen level dependence (BOLD) has attracted researchers'interest. Magnetic susceptibility imaging (MSI) is sensitive to deoxygenated hemoglobin (DHB) in blood vessels, and DHB content in ischemic tissue is different from that in normal tissue, so it can be used as an indirect method. The purpose of this study was to investigate the application and mechanism of abnormally low signal intensity of cerebral vein on SWI in intravenous thrombolysis of acute cerebral infarction.
Part one: the degree of venous asymmetry in susceptibility weighted imaging is related to perfusion defects.
AIM: To hypothesize that low signal asymmetry in the superior vein of magnetic resonance imaging (SWI) (3.0T) can reflect the size of perfusion defect in ischemic stroke.
Methods: We retrospectively reviewed prospectively registered intravenous thrombolysis databases and included patients with anterior circulation cerebral infarction who underwent multimodal MRI before and after intravenous thrombolysis. The absolute change of intravenous AI (AAI) was defined as the difference between baseline AI and 24-hour AI, and the relative change (r Delta AI) was defined as the ratio of baseline AI to 24-hour AI. The changes of venous asymmetry after thrombolysis were compared with nonparametric tests.
Results: The TIMI (thrombosis in myocardial infarction flow grading) was lower in low ASPECTS group than in high ASPECTS group (I 6550 1) VS2 (IQR: 0-3), P = 0.002, P = 0.002, larger low perfusion volume (120 (+ 83 ml vs 58 (+ 67 ml, P = 0.004). The AI changes in patients with recanalization were greater than those without recanalization (delAI: 1.20 vs 0.11, P 0.001; R (delAI: 1.20 vs 0.11, 0.11, P 0.001; R delAI: 3.54vs 1.11, P 0.11, P 0.001); the AIchanges in reperpatients were also greater (delAI: 0.93 AI: 0.93 vs 0.12, vs 0.12, P = 0.12, v = 0.031; AArI: 2.06vs 1.06vs 1.2.B: Yes, it is.
Conclusion: SWI venous asymmetry can reflect the volume of perfusion defect in patients with acute ischemic stroke, and venous asymmetry can be reversed after reperfusion.
The second part is the predictive effect of SWI-DWI mismatch on the efficacy of intravenous thrombolysis.
BACKGROUND AND METHODS: Cerebral venous asymmetry on magnetic susceptibility-weighted imaging (SWI) indirectly reflects cerebral hypoxia. In this study, we investigated whether SWI-DWI with obvious superior venous asymmetry and small lesions on DWI did not match with SWI-DWI. To predict the efficacy of intravenous thrombolysis.
Methods: We retrospectively reviewed prospectively registered intravenous thrombolysis databases and included patients with anterior circulation cerebral infarction who underwent multimodal MRI before intravenous thrombolysis. Good outcomes were 0-2 points for modified Rankin Scale (mRS) at 3 months. Single and multivariate analysis showed that SWI-DWI mismatch was an independent predictor of good outcomes.
Results: 54 patients with SWI-DWI mismatch had a higher proportion of good prognosis than those without SWI-DWI mismatch (78% vs 44%; OR = 6.317; 95% CI: 1.12-35.80, P = 0.037). Patients with SWI-DWI mismatch had better prognosis from reperfusion (91% vs 43%, P = - 0.033), recanalization (100% vs 40%, P = 0.013). The accuracy of predicting good prognosis was higher than that of perfusion weighted imaging diffusion-weighted imaging (63%vs48.1%).
Conclusion: SWI-DWI mismatch can predict the efficacy of intravenous thrombolysis, and may be used to screen patients who benefit from intravenous thrombolysis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R743.3
本文編號：2204952
[Abstract]:Research background
Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is one of the effective therapies recommended by clinical guidelines for acute ischemic stroke. The goal of thrombolysis is to restore the perfusion of ischemic tissue, which is due to ischemia. Neurons that are in a state of disfunction but not yet organically dead can be rescued after revascularization, and these "functionally impaired but non-organically dead" tissues can be rescued in the penumbra.
At present, imaging technology can be used to reflect the physiological and pathological changes of stroke. Positron emission tomography (PET) and magnetic resonance imaging (MRI) are the main research methods. PET is the gold standard used to evaluate the penumbra in clinic. It uses various metabolic parameters. Number and ligand imaging techniques are used to assess the penumbra and core infarct tissues, but PET is not widely used in clinic. MRI uses the difference of lesions between Perfusion-Weighted Imaging (PWI) and Diffusion-Weighted Imaging (DWI) sequences to represent the penumbra, but the perfusion defect defined by PWI lacks a good one. Well validated and widely recognized threshold.
Recently, magnetic susceptibility-weighted imaging (SWI) based on the principle of blood oxygen level dependence (BOLD) has attracted researchers'interest. Magnetic susceptibility imaging (MSI) is sensitive to deoxygenated hemoglobin (DHB) in blood vessels, and DHB content in ischemic tissue is different from that in normal tissue, so it can be used as an indirect method. The purpose of this study was to investigate the application and mechanism of abnormally low signal intensity of cerebral vein on SWI in intravenous thrombolysis of acute cerebral infarction.
Part one: the degree of venous asymmetry in susceptibility weighted imaging is related to perfusion defects.
AIM: To hypothesize that low signal asymmetry in the superior vein of magnetic resonance imaging (SWI) (3.0T) can reflect the size of perfusion defect in ischemic stroke.
Methods: We retrospectively reviewed prospectively registered intravenous thrombolysis databases and included patients with anterior circulation cerebral infarction who underwent multimodal MRI before and after intravenous thrombolysis. The absolute change of intravenous AI (AAI) was defined as the difference between baseline AI and 24-hour AI, and the relative change (r Delta AI) was defined as the ratio of baseline AI to 24-hour AI. The changes of venous asymmetry after thrombolysis were compared with nonparametric tests.
Results: The TIMI (thrombosis in myocardial infarction flow grading) was lower in low ASPECTS group than in high ASPECTS group (I 6550 1) VS2 (IQR: 0-3), P = 0.002, P = 0.002, larger low perfusion volume (120 (+ 83 ml vs 58 (+ 67 ml, P = 0.004). The AI changes in patients with recanalization were greater than those without recanalization (delAI: 1.20 vs 0.11, P 0.001; R (delAI: 1.20 vs 0.11, 0.11, P 0.001; R delAI: 3.54vs 1.11, P 0.11, P 0.001); the AIchanges in reperpatients were also greater (delAI: 0.93 AI: 0.93 vs 0.12, vs 0.12, P = 0.12, v = 0.031; AArI: 2.06vs 1.06vs 1.2.B: Yes, it is.
Conclusion: SWI venous asymmetry can reflect the volume of perfusion defect in patients with acute ischemic stroke, and venous asymmetry can be reversed after reperfusion.
The second part is the predictive effect of SWI-DWI mismatch on the efficacy of intravenous thrombolysis.
BACKGROUND AND METHODS: Cerebral venous asymmetry on magnetic susceptibility-weighted imaging (SWI) indirectly reflects cerebral hypoxia. In this study, we investigated whether SWI-DWI with obvious superior venous asymmetry and small lesions on DWI did not match with SWI-DWI. To predict the efficacy of intravenous thrombolysis.
Methods: We retrospectively reviewed prospectively registered intravenous thrombolysis databases and included patients with anterior circulation cerebral infarction who underwent multimodal MRI before intravenous thrombolysis. Good outcomes were 0-2 points for modified Rankin Scale (mRS) at 3 months. Single and multivariate analysis showed that SWI-DWI mismatch was an independent predictor of good outcomes.
Results: 54 patients with SWI-DWI mismatch had a higher proportion of good prognosis than those without SWI-DWI mismatch (78% vs 44%; OR = 6.317; 95% CI: 1.12-35.80, P = 0.037). Patients with SWI-DWI mismatch had better prognosis from reperfusion (91% vs 43%, P = - 0.033), recanalization (100% vs 40%, P = 0.013). The accuracy of predicting good prognosis was higher than that of perfusion weighted imaging diffusion-weighted imaging (63%vs48.1%).
Conclusion: SWI-DWI mismatch can predict the efficacy of intravenous thrombolysis, and may be used to screen patients who benefit from intravenous thrombolysis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R743.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 Ulf Jensen-Kondering;Ruwen B銉hm;;Asymmetrically hypointense veins on T2~*w imaging and susceptibility-weighted imaging in ischemic stroke[J];World Journal of Radiology;2013年04期
，本文編號：2204952
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