弥散加权成像高信号完全可逆的急性缺血性卒中病例临床及影像学特征分析

目的 分析急性缺血性卒中完全可逆性DWI高信号病例的临床与影像学特征。 方法 回顾性分析2012年1月-2015年12月的急性缺血性卒中完全可逆性DWI高信号病例9例,通过 基线与随访数据评估其临床与影像学特征。 结果 急性缺血性卒中完全可逆性DWI高信号病例基线NIHSS评分为1（1～2.5）分,基线DWI高信号 体积为0.94（0.28～2.39）mL,病变既见于皮层/皮层下,又见于深部白质,随访90 d的mRS评分为0 （0～1）分。 结论 急性缺血性卒中完全可逆性DWI高信号多见于轻型卒中,病灶梗死体积小,临床预后良好。     

循证临床指南：磁共振弥散及灌注成像在急性缺血性卒中诊断中的作用—一项美国神经病学学会治疗和技术评估小组的报告

目的 评估弥散加权成像（diffusion-weighted imaging,DWI）和灌注加权成像（perfusion-weightedimaging,PWI）在急性缺血性卒中的诊断价值。方法 系统分析1966～2008年1月的文献,以确定DWI和PWI对急性缺血性卒中诊断和预后的价值。结果和推荐 对于发病12小时以内急性缺血性卒中的诊断,DWI是有效的,并且优于计算机断层扫描（computer tomography,CT）平扫。应使用DWI确诊大多数的急性缺血性卒中（A级）;但是,对于可能患有急性卒中的患者来说,DWI诊断的灵敏性仍不完美。DWI用于评估脑出血时的诊断准确性不在本指南范围之内。基于Ⅱ类和Ⅲ类证据,采用基线DWI病变体积可以大概预测前循环卒中的基线卒中严重程度（B级）,但恐怕不能预测椎基底动脉区域卒中的严重程度（C级）。基线DWI病变体积可以大概预测（最终的）梗死的大小（B级）,并可能预测早期和晚期临床结局（C级）。与DWI相比,基线PWI体积在预测基线卒中的严重程度方面不如DW（I C级）。没有充分的证据支持或否认PWI对急性缺血性卒中的诊断价值（U级）。①建议证据类型,Ⅰ类：有证据表明和（或）普遍共识表明该措施或治疗有用、有效;Ⅱ类：关于该措施或治疗的有用性/有效性存在着证据冲突和（或）意见分歧;Ⅲ类：有证据表明和（或）普遍共识表明该措施或治疗无用/无效,而且某些情况下甚至可能有害;②推荐等级,A级：数据来自于多个临床随机试验或荟萃分析;B级：数据来自于单个随机试验或非随机研究;C级：数据来自于专家统一意见、个案研究或医疗标准;U级：数据缺乏证据或证据不足。     

表观弥散系数对确定急性缺血性卒中缺血半暗带的潜在价值

目的 探讨表观弥散系数（apparent diffusion coefficient,ADC）对确定急性缺血性卒中缺血半暗带的潜在价值。 方法 选择发病9 h内完成多模式磁共振成像（magnetic resonance imaging,MRI）检查的前循环急性缺血性卒中患者49例。应用自制软件进行灌注加权像（perfusion-weighted imaging,PWI）和弥散加权像（diffusion-weighted imaging,DWI）异常区域的体积测量。缺血半暗带以PWI/DWI错配表示。同时采用全自动图像分析系统,以DWI图像计算得到的ADC图作为输入数据,来判断缺血半暗带的存在（以下简称为ADC方法）,然后比较这两种方法在判断缺血半暗带方面的差异。 结果 入选的49例患者中,存在PWI/DWI错配者为43例,符合ADC方法判断缺血半暗带标准者有41例。这两种方法在判断是否存在缺血半暗带的结果中有41例相符,对判断缺血半暗带的差异无统计学意义（P>0.05）。ADC方法判断缺血半暗带的敏感度为88.4%、特异度为50.0%。 结论 由于不需做PWI检查,ADC方法对确定缺血半暗带具有潜在的临床实用价值,有可能成为一种简便易行的确定缺血半暗带的方法。     

磁共振多层并采扩散峰度成像与传统扩散加权成像识别急性缺血性卒中梗死核心的研究

目的与磁共振成像(magnetic resonance imaging,MRI)传统扩散加权成像(diffusion weighted imaging,DWI)对比,探讨MRI多层并采扩散峰度成像(multi-band EPI diffusion kurtosis imaging,m-DKI)界定急性缺血性卒中梗死核心的准确性。方法选择在发病3~8 h进行MRI检查的急性缺血性卒中患者,所有患者经灌注加权成像(perfusion weighted imaging,PWI)判定不存在缺血半暗带,没有接受静脉溶栓/动脉取栓治疗。基线扫描时加入传统DWI以及m-DKI序列,并在患者发病亚急性期([7±1)d]复查MRI扫描,利用Mricron软件分别对基线MRI检查表观扩散系数(apparent diffusion coefficient,ADC)图,平均扩散峰度(mean kurtosis,MK)图以及复查MRI T_1加权成像(T_1 weighted imaging,T_1WI)责任病灶体积进行测量,分别计算ADC图、MK图与T_1WI责任病灶体积的差值,并进行比较。结果入组的19例患者,1例患者DWI显示缺血病灶,但MK图及复查MRI均未见责任病灶;1例患者病灶位于基底节区附近,影响MK图责任病灶观察及测量。余17例患者MK图显示责任病灶的体积与亚急性期T_1WI责任病灶体积的差值为(0.25±0.37),而ADC图显示责任病灶的体积与亚急性期T_1WI体积的差值为(0.73±0.72)(t=3.968,P=0.001)。MK图责任病灶的体积更接近T_1WI的体积。结论与传统DWI相比,基线m-DKI显示责任病灶的体积更接近复查T_1WI的体积,对最终梗死核心的界定更为准确。     

基于DSA评估毛细血管状态与缺血性卒中血管内治疗预后的相关性

目的研究基于全脑血管造影术评估毛细血管状态与急性前循环缺血性卒中血管内治疗疗效与预后的相关性,探讨侧支循环在再灌注治疗过程中的保护作用。方法回顾性分析2020年1月-2020年12月间发病24 h时以内的急性前循环大动脉闭塞患者。采用毛细血管指数评分(CIS)对缺血脑组织的责任血管区域进行侧支循环评估,并根据CTP灌注成像的核心梗死体积和术后1 w内头部MR的DWI影像结果,计算最终梗死体积和进展梗死体积,并随访患者临床预后及与远期功能恢复。结果 (1)基线ASPECTS评分(OR=2.246,95%CI 1.084～6.328,P 0.05)、大脑中动脉M1或M2闭塞(OR=4.801,95%CI 2.047～11.261,P 0.001)是侧支循环的独立影响因素;(2)基线ASPECT评分(OR=6.476,95%CI 1.618～21.921,P 0.001)、侧支循环(OR=12.304,95%CI 5.035～28.348,P 0.01)及出院NIHSS评分(OR=0.637,95%CI 0.473～0.858,P 0.01)是取栓患者3个月预后的独立影响因素。结论基于DSA评估毛细血管状态对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积及临床预后有良好的预测作用,侧支循环结合发病时间窗有助于筛选可能在血管内治疗中获益的AIS患者。     

糖尿病患者颈动脉斑块磁共振成像特征与急性脑缺血病灶形态关系研究

目的 探讨2型糖尿病患者颈动脉斑块磁共振成像（magnetic r esonance i maging，MRI）特征与相应供 血区急性脑缺血病灶形态的关系。 方法 横断面研究，入组临床急性颈内动脉供血区缺血性卒中患者，排除心源性卒中，在发病一周 内行颈动脉磁共振管壁成像（magnetic resonance vessel wall imaging，MR-VWI）检查和常规MRI [包括 磁共振血管成像（magnetic resonance angiography，MRA）和弥散加权成像（diffusion-weighted imaging， DWI）]检查，评估症状侧颈动脉斑块负荷和成分特征以及颅内外动脉管腔狭窄度，根据DWI上梗死灶 形态对急性脑缺血病灶形态和体积进行分析。 结果 共入选140例急性缺血性卒中患者，其中68例（48.6%）为2型糖尿病患者，多因素回归分析显 示2型糖尿病是症状侧颈动脉斑块富脂质核发生的独立危险因素[比值比（odds ratio，OR）3.35，95% 可信区间（confidence interval，CI）1.33～8.43]；在兼具富脂质核斑块的患者中，2型糖尿病组颈内动脉 区域急性脑缺血病灶体积（[ 15.45±8.97）ml vs（9.09±8.64）ml，P=0.011]和大穿支动脉梗死发生率 [34.0% vs 13.2%，P =0.024）]显著高于非糖尿病组。 结论 颈动脉供血区急性缺血性卒中患者中，2型糖尿病与症状侧颈动脉动脉粥样硬化斑块MRI特征， 尤其是富脂质核密切相关，且更易发生大穿支动脉的梗死，提示MR-VWI细致化分析结合糖尿病因素 有助于临床对缺血性卒中风险的分层和个体化诊治。     

超早期磁共振血管成像无大血管闭塞的急性缺血性卒中患者的预后

目的研究超早期磁共振血管成像(MRA)无大血管闭塞的急性缺血性卒中患者的临床结局及预测结局的因素。方法选择超早期(发病6 h内)完成急诊磁共振成像(MRI)检查且MRA无大血管闭塞的急性缺血性卒中患者31例,收集其临床及影像学数据,在MRI检查前完成NIHSS评分,随访发病后24 h的NIHSS评分及3个月时mRS评分。结果31例患者中28例MRI弥散加权成像(DWI)提示梗死灶,治疗后24 h时NIHSS显著改善者17例,3个月随访mRS0-2分者28例,未发现预测结局的因素。结论超早期MRA无大血管闭塞的急性缺血性卒中患者中大部分DWI可见责任梗死灶,即使未溶栓,大多数患者临床结局也较好。     

缺血性小卒中患者1年卒中复发的相关因素分析——来自中国颅内动脉粥样硬化研究的数据

目的通过分析急性期缺血性小卒中患者磁共振成像(magnetic resonance imaging,MRI)弥散加权成像(diffusion weighted imaging,DWI)的病灶模式及磁共振血管成像(magnetic resonance angiography,MRA)/增强磁共振血管成像(contrast enhanced magnetic resonance angiography,CE-MRA)反映的大血管病变情况,结合临床信息,探讨对小卒中1年卒中复发有较强预测作用的评价指标。方法以中国颅内动脉粥样硬化研究(Chinese Intra Cranial Atherosclerosis Study,CICAS)数据库中的患者资料为数据来源,纳入发病7 d内、病前改良Rankin量表(modified Rankin Scale,m RS)评分≤2分、脑部MRI-DWI发现新梗死病灶、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4分的缺血性卒中患者;收集患者的基线信息和影像信息所示不同病变模式及大血管病变情况,以单变量分析和多变量分析确定小卒中后1年卒中复发的预测因素。结果本研究最终纳入843例缺血性小卒中患者,平均年龄(61.67±11.04)岁。1年累计卒中复发率4.39%。1年预后的Cox回归分析结果显示:年龄75岁[风险比(hazard ratio,HR)3.18,95%可信区间(confidence interval,CI)1.140~7.211,P=0.006)],症状相关性动脉闭塞(HR 2.35,95%CI 1.094~5.030,P=0.029),多发非症状相关性动脉狭窄(HR 2.74,95%CI 1.311~5.730,P=0.007),多发皮层、皮层下和(或)深部白质梗死(HR 2.06,95%CI 1.006~4.229,P=0.048)是1年卒中复发的独立预测因子。结论急性缺血性小卒中患者影像学检查对于判断预后有重要意义,DWI所示多发皮层、皮层下和(或)深部白质病变、多发颅内外动脉狭窄是小卒中1年卒中复发的独立预测因子。     

急性大脑中动脉栓塞患者梗死灶的核磁共振影像学特点

目的分析急性心源性栓塞性大脑中动脉M1段闭塞后脑梗死的磁共振影像学特点。方法对符合TOAST标准心源性栓塞脑梗死并且DWI、MRA证实为急性大脑中动脉M1段闭塞脑梗死33例患者进行入院时病灶体积、形态及NIHSS评分及入院2周的NIHSS评分。结果（1）入院时DWI显示的梗死体积为（65．62±84．72）mm,NIHSS评分为（11．65±8．51）分;多发病灶15例（45．45％）,单发病灶18例（54．55％）;（2）入院2周时梗死体积与NIHSS评分呈正相关（r=0．625,P〈（）．05）,症状改善情况（入院时NIHSS评分一入院2周NIHSS评分）为（5．73±9．27）分。（3）梗死灶包括皮层＋皮层下梗死、皮层＋皮层梗死及多发皮层下梗死。结论急性心源性栓塞性大脑中动脉M1闭塞后梗死体积与发病后2周的预后有关;梗死灶形态表现多样。     

急性脑卒中低灌注强度比值与梗死体积增长、预后的相关性研究

目的探讨急性脑卒中血管内机械取栓(EVT)治疗前低灌注强度比值(HIR)与梗死体积增长及预后的相关性。方法根据HIR将100例急性缺血性脑卒中患者分为侧支循环丰富组(HIR 0.4)及侧支循环不丰富组(HIR≥0.4)。分析HIR与梗死体积增长及预后的相关性,并采用ROC曲线分析HIR对卒中预后的预测价值。结果侧支循环丰富组治疗前DWI梗死体积、脑血流达峰时间(Tmax) 6 s体积、Tmax 10s体积、治疗后DWI梗死体积、梗死体积增长及3个月mRS评分明显低于侧支循环不丰富组,差异有统计学意义(t=5.255,P 0.001; t=3.267,P=0.002; t=5.076,P 0.001; t=6.241,P 0.001; t=6.263,P 0.001; t=6.640,P 0.001),余临床资料差异无统计学意义(均P 0.05)。Spearman相关分析显示,HIR与梗死体积(r=0.545,P 0.001)、3个月mRS评分(r=0.629,P 0.001)呈正相关。ROC分析显示,HIR预测卒中预后的曲线下面积为0.864(95%CI:0.788～0.939)。当HIR的最佳临界值为0.40时,预测卒中预后的敏感性和特异性分别为78.30%和83.30%。结论急性缺血性脑卒中患者EVT治疗前低HIR与较慢的梗死体积增长、较好的功能预后密切相关。HIR 0.4是预测卒中预后的最佳值。     

建立急性缺血性卒中的临床/多模式CT预后评分系统

目的 建立一个简便、有效的临床/多模式CT评分系统,用以指导急性缺血性卒中患者的临床治疗和评估90 d后临床功能恢复情况。方法 选择49例急性缺血性卒中（发病时间＜9 h）的患者行“多模式CT”扫描,包括平扫CT（non-contrast enhanced computed tomography,NCCT）、CT灌注成像（computed tomography perfusion,CTP）和CT血管成像（computed tomography angiography,CTA）;评价患者基线NCCT、动脉期CTP原始图（arterial phase CTP source images,ACTP-SI）、静脉期CTP原始图（venous phase CTP source images,VCTP-SI）、CTA卒中溶栓分级（thrombolysis in cerebral ischemia scale,TICI）、Alberta卒中项目早期CT评分（Alberta Stroke Program Early CT Score Study,ASPECTS）及基线美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）评分,并应用受试者工作特征曲线（receiver-operating characteristics,ROC）分析,判断90 d临床功能恢复良好［采用改良的Rankin量表（modified Rankin Scale,mRS）<2作为评判标准］的临床和CT参数阈值;按照获得的阈值进行评分,将多模式CT各参数的阈值评分整合在一起获得多模式CT评分系统,将基线NIHSS阈值评分加入多模式CT评分系统中获得临床/多模式CT评分。最后应用ROC曲线分析比较各评分模式预测临床功能恢复的效能。结果 判断90 d临床功能恢复良好的阈值：临床/多模式CT评分>1,多模式CT评分>1,基线NCCT ASPECTS>9,动脉期CTP原始图ASPECTS>6.5,静脉期CTP原始图ASPECTS>8.5,CTA TICI>1及基线NIHSS≥7;临床/多模式CT评分ROC曲线下面积最大（0.87,95%可信区间0.75～0.95),其预测急性缺血性卒中患者90 d临床功能恢复的效能最高,接下来依次是多模式CT评分、ACTP-SI、VCTP-SI、NIHSS、NCCT及CTA,除临床/多模式CT评分与ACTP-SI（P=0.226）及NIHSS阈值评分（P=0.174）的差异显著性外,其余各参数阈值评分与临床/多模式CT评分的差异均有显著性（P＜0.05）。结论 应用临床/多模式CT评分系统比多模式CT及NIHSS各参数单独预测90 d急性缺血性卒中患者的临床功能恢复的效能均高,临床/多模式CT评分系统是预测患者预后的有效评分方法。     

脑干梗死不同阶段梗死灶体积和ADC值的演变及其与临床预后关系的研究

目的通过对脑干梗死患者发病不同阶段的MRI随访研究,结合患者临床运动功能恢复情况,揭示梗死灶体积和表观扩散系数（ADC）值的演变规律,及其与临床症状和预后的关系。方法选择11例首次发病的脑干梗死患者,分别于发病后不同时间（〈7d、15d和1、3、6个月）测量梗死灶体积和ADC值,计算病灶与健侧相应部位的相对ADC（rADC）值;采用Fugl-Meyer运动量表（FMMS）进行临床运动功能评价,并分析梗死灶体积、rADC值与患者运动功能之间的相关关系。结果发病后脑干梗死灶体积逐渐缩小（F=4．553,P=0．003）,rADC值逐渐升高（,=22．991,P=0．000）,除发病7d内的脑干梗死灶体积与同期FMMS评分呈负相关关系（r=-0．686,P=0．020）,其余各测量时间点脑干梗死灶体积和不同时期rADC值均与FMMs评分无相关关系（P〉0．05）。结论脑干梗死灶体积和rADC值随病程的演变呈动态变化,具有规律性,但与患者运动功能恢复情况无明显相关性。     

Early magnetic resonance imaging prediction of arterial recanalization and late infarct volume in acute carotid artery stroke.

In patients with acute ischemic stroke, early recanalization may save tissue at risk for ischemic infarction, thus resulting in smaller infarcts and better clinical outcome. The hypothesis that clinical and diffusion- and perfusion-weighted imaging (DWI, PWI) parameters may have a predictive value for early recanalization and final infarct size was assessed. Twenty-nine patients were prospectively enrolled and underwent sequential magnetic resonance imaging (1) within 6 hours from hemispheric stroke onset, before thrombolytic therapy; (2) at day 1; and (3) at day 60. Late infarct volume was assessed by T2 -weighted imaging. At each time, clinical status was assessed by the National Institutes of Health Stroke Scale (NIHSS). Twenty-eight patients had arterial occlusion at day 0 magnetic resonance angiography (MRA). They were classified into two groups according to day 1 MRA: recanalization (n = 18) versus persistent occlusion (n = 10). Any significant differences between these groups were assessed regarding (1) PWI and DWI abnormality volumes, (2) relative and absolute time-to-peak (TTP) and apparent diffusion coefficient within the lesion on DWI; and (3) day 60 lesion volume on T2 -weighted imaging. Univariate and multivariate logistic regression analysis showed that the most powerful predictive factors for recanalization were lower baseline NIHSS score and lower baseline absolute TTP within the lesion on DWI. The best predictors of late infarct size were day 0 lesion volume on DWI and day 1 recanalization. Early PWI and DWI studies and day 1 MRA provide relevant predictive information on stroke outcome.     

Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis

Šaňák D, Herzig R, Zapletalová J, Horák D, Král M, Školoudík D, Bártková A, Veverka T, Heřman M, Kaňovský P. Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis.
Acta Neurol Scand: 2011: 123: 339–344.
© 2010 John Wiley & Sons A/S. Objectives – Intravenous thrombolysis (IVT) is considered an effective treatment for acute ischemic stroke (IS). However, not all treated patients may achieve good outcome. The aim was to evaluate whether the initial NIHSS and DWI infarct volume could be the predictors for good outcome after IVT. Patients and Methods – The set of 125 patients with consecutive hemispheric IS (78 men; mean age 66.0 ± 12.1 years) treated with IVT within 3 h was analyzed. DWI volume was measured on admission. Good outcome was defined as a score 0‐2 in modified Rankin Scale. Results – Multivariate logistic regression analysis showed initial NIHSS as an independent predictor of good outcome (P = 0.001). ROC curves showed baseline NIHSS ≤13.5 points and DWI volume ≤13.7 ml as cut‐offs related to good outcome. Conclusions – The initial NIHSS and DWI volume might be the predictors for good clinical outcome in acute stroke patients treated with IVT. The initial NIHSS score seems to be more accurate.     

Influence of pretreatment MRI parameters on clinical outcome, recanalization and infarct size in 49 stroke patients treated by intravenous tissue plasminogen activator

We hypothesized that pretreatment magnetic resonance imaging (MRI) parameters might predict clinical outcome, recanalization and final infarct size in acute ischemic stroke patients treated by intravenous recombinant tissue plasminogen activator (rt-PA). MRI was performed prior to thrombolysis and at day 1 with the following sequences: magnetic resonance angiography (MRA), T2*-gradient echo (GE) imaging, diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI). Final infarct size was assessed at day 60 by T2-weighted imaging (T2-WI). The National Institutes of Health Stroke Scale (NIHSS) score was assessed prior to rt-PA therapy and the modified Rankin Scale (m-RS) score was assessed at day 60. A poor outcome was defined as a day 60 m-RS score >2. Univariate and multivariate logistic regression analyses were used to identify the predictors of clinical outcome, recanalization and infarct size. Forty-nine patients fulfilled the inclusion criteria. Baseline NIHSS score was the best independent indicator of clinical outcome (p=0.002). A worse clinical outcome was observed in patients with tandem internal carotid artery (ICA)+middle cerebral artery (MCA) occlusion versus other sites of arterial occlusion (p=0.009), and in patients with larger pretreatment PWI (p=0.001) and DWI (p=0.01) lesion volumes. Two factors predict a low rate of recanalization: a proximal site of arterial occlusion (p=0.02) and a delayed time to peak (TTP) on pretreatment PWI (p=0.05). The final infarct size was correlated with pretreatment DWI lesion volume (p=0.025). Recanalization was associated with a lower final infarct size (p=0.003). In conclusion, a severe baseline NIHSS score, a critical level of pretreatment DWI/PWI parameters and a proximal site of occlusion are predictive of a worse outcome after IV rt-PA for acute ischemic stroke.     

The Use of PWI and DWI Measures in the Design of "Proof-of-Concept" Stroke Trials

BACKGROUND AND PURPOSE: The authors used serial magnetic resonance perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) to determine whether major reperfusion and the attenuation of infarct expansion are associated with improved stroke outcome. METHODS: Forty-nine patients were studied with serial magnetic resonance imaging within 6 hours of stroke onset and again at 4 days (subacute studies) and 3 months (outcome studies). Two imaging parameters were examined: infarct expansion between acute and outcome studies and major reperfusion between acute and subacute studies. RESULTS: Patients with major reperfusion (45% of those with acute PWI lesions) were more likely to have little or no disability at outcome (National Institutes of Health Stroke Scale [NIHSS] score < or = 4, P = .0176; Barthel Index [BI] score > or = 90, P = .0547) after adjustment for baseline differences. In contrast, patients with infarct expansion (48%) were more likely to be dead or dependent at outcome (BI < 90, P = .0414; NIHSS score P = .082; modified Rankin Scale score > 2, P < .0001). These measures were used to generate sample size calculations based on hypothetical treatment effects. Therapies postulated to double the proportion of patients with major reperfusion from one third to two thirds would require 41 patients in each group (treated and untreated) to be sufficiently powered to show a difference. Interventions postulated to halve the number of patients with infarct expansion from 50% to 25% would require 66 patients in each group to show a difference. CONCLUSIONS: Infarct expansion and major reperfusion are associated with clinically meaningful changes in stroke outcome. These measures could be used as surrogate markers of outcome in late phase II proof-of-concept stroke studies designed to provide efficacy signals before embarking on large phase III studies with definitive clinical endpoints.     

磁共振灌注成像－弥散成像不匹配对指导超时间窗急性缺血性卒中患者溶栓的价值

目的 探讨磁共振灌注成像－弥散成像（perfusion weighted imaging-diffusion weighted imaging,PWI-DWI）不匹配对指导超时间窗（>6h）的急性缺血性卒中患者溶栓的价值。方法 选择在发病12h内完成磁共振检查,且（PWI-DWI）/DWI×100%>30%的40例急性缺血性卒中患者,分为溶栓组和对照组,溶栓组给予重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）0.6～0.9mg/kg静脉溶栓治疗,对照组常规治疗。两组患者在溶栓前、溶栓后1周、2周、3个月分别行美国国立卫生院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分,溶栓前、溶栓后2周、3个月分别行日常生活能力量表（activities of daily living,ADL）评分。结果 溶栓组在溶栓后1周、2周、3个月NIHSS评分均较对照组降低（P<0.01）;在2周和3个月,溶栓组ADL评分较对照组明显升高（P<0.01）。结论 在PWI>DWI影像学模式指导下,适当延长急性缺血性卒中的溶栓时间窗具有可行性。     

艾森量表和精简的艾森量表预测中国非心房颤动性缺血性卒中患者复发的准确性

目的 在非心房颤动型卒中患者中,验证艾森卒中风险评分量表(Essen Stroke Risk Score,ESRS)预测卒中复发的准确性,将艾森卒中量表给予改良,并对改良后的艾森量表进行验证.方法 分析连续住院治疗的510例脑梗死患者的资料,依照艾森卒中量表给予评分,1年后随访到468例患者,按照随访结果将其分为复发组...     

Visual evaluation of perfusion computed tomography in acute stroke accurately estimates infarct volume and tissue viability

OBJECTIVE: To establish the validity of visual interpretation of immediately processed perfusion computed tomography (CT) maps in acute stroke for prediction of final infarction. METHODS: Perfusion CT studies acquired prospectively were reprocessed within six hours of stroke onset using standard CT console software. Four contiguous 5 mm thick images were obtained and maps of time to peak (TTP) and cerebral blood volume (CBV) generated. Volumes of lesions identified only by visual inspection were measured from manually drawn regions of interest. Volumes of tissue with prolonged TTP or reduced CBV were compared with independently calculated volume of infarction on non-contrast CT (NCCT) at 24-48 hours, and with clinical severity using the NIHSS score. Arterial patency at 24-48 h was included in analyses. RESULTS: Studies were analysed from 17 patients 150 minutes (median) after stroke onset. Volume of tissue with prolonged TTP correlated with initial NIHSS (r = 0.62, p = 0.009), and with NCCT final infarct volume when arterial occlusion persisted (r = 0.953, p = 0.012). Volume of tissue with reduced CBV correlated with final infarct volume if recanalisation occurred (r = 0.835, p = 0.001). Recanalisation was associated with lower 24 h NIHSS score (6 (IQR, 5 to 9.5) v 19 (18 to 26), p = 0.027), and in 10 patients given rtPA for MCA M1 occlusion, with lower infarct volume (73 v 431 ml, p = 0.002). CONCLUSIONS: Visual evaluation of TTP and CBV maps generated by standard perfusion CT software correlated with 24-48 hour CT infarct volumes. Comparison of TTP and CBV maps yields information on tissue viability. Perfusion CT represents a practical technique to aid acute clinical decision making. Recanalisation was a crucial determinant of clinical and radiological outcome.     

Essen评分在TIA、缺血性小卒中与大卒中 患者中预测效度的比较

目的 比较Essen卒中风险分层量表（Essen Stroke Risk Score,ESRS）预测短暂性脑缺血发作（transient
ischemic attack,TIA）、缺血性小卒中和缺血性大卒中患者的卒中复发和联合血管事件发生的效度。
方法 以前瞻性、多中心中国国家卒中登记研究（China National Stroke Registry,CNSR）中连续录入
的11 384例完成1年随访的TIA、非心房颤动性缺血性卒中的住院患者为研究人群,小卒中定义为入院
时缺血性卒中患者的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）
评分≤3分,大卒中定义为NIHSS评分＞3分。采用曲线下面积（area under the curve,AUC）评价ESRS对
TIA、缺血性小卒中和大卒中患者进行卒中复发和联合血管事件复发风险的分层能力,预测卒中复发
和联合血管事件发生的效度。
结果 本研究有1061例TIA,3254例小卒中,7069例大卒中患者。在TIA患者中,ESRS预测卒中复发
AUC=0.57,预测联合血管事件AUC=0.56;小卒中患者中,ESRS预测卒中复发的AUC=0.58,预测联合
血管事件AUC=0.59;大卒中患者中,ESRS预测卒中复发的AUC=0.60,预测联合血管事件AUC=0.60。
结论 ESRS评分对大卒中的卒中复发/联合血管事件发生的预测效度最高,其次是对小卒中,在TIA
中预测效度最低,但是三组人群中差异无显著性。