Blood-brain barrier permeability by CT perfusion predicts parenchymal hematoma after recanalization with thrombectomy

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2023-11-29 DOI:10.1111/jon.13172
Xinyi Chen, Jie Xu, Shunyuan Guo, Sheng Zhang, Huiyuan Wang, Panpan Shen, Yafei Shang, Mingming Tan, Yu Geng
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Abstract

Background and Purpose

Parenchymal hematoma is a dreaded complication of mechanical thrombectomy after acute ischemic stroke. This study evaluated whether blood-brain barrier permeability measurements based on CT perfusion could be used as predictors of parenchymal hematoma after successful recanalization and compared the predictive value of various permeability parameters in patients with acute ischemic stroke.

Methods

We enrolled 53 patients with acute ischemic stroke who underwent mechanical thrombectomy and achieved successful recanalization. Each patient underwent CT, CT angiography, and CT perfusion imaging before treatment. We used relative volume transfer constant (rKtrans) values, relative permeability–surface area product (rP·S), and relative extraction fraction (rE) to evaluate preoperative blood-brain barrier permeability in the delayed perfusion area.

Results

Overall, 22 patients (37.7%) developed hemorrhagic transformation after surgery, including 10 patients (16.9%) with hemorrhagic infarction and 11 patients (20.8%) with parenchymal hematoma. The rP·S, rKtrans, and rE of the hypoperfusion area in the parenchymal hematoma group were significantly higher than those in the hemorrhagic infarction and no-hemorrhage transformation groups (p < .01). We found that rE and rP·S were superior to rKtrans in predicting parenchymal hematoma transformation after thrombectomy (P·S area under the curve [AUC] .844 vs. rKtrans AUC .753, z = 2.064, p = .039; rE AUC .907 vs. rKtrans AUC .753, z = 2.399, p = .017).

Conclusions

Patients with parenchymal hematoma after mechanical thrombectomy had higher blood-brain barrier permeability in hypoperfusion areas. Among blood-brain barrier permeability measurement parameters, rP·S and rE showed better accuracy for parenchymal hematoma prediction.

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CT灌注血脑屏障通透性预测取栓再通后脑实质血肿。
背景与目的:脑实质血肿是急性缺血性脑卒中机械取栓术中一种可怕的并发症。本研究评估了基于CT灌注的血脑屏障通透性测量是否可以作为脑实质血肿再通成功后的预测指标,并比较了各种通透性参数在急性缺血性脑卒中患者中的预测价值。方法:我们招募了53例急性缺血性脑卒中患者,他们接受了机械取栓术并成功地实现了再通。治疗前均行CT、CT血管造影、CT灌注成像。我们使用相对体积传递常数(rKtrans)值、相对透性-表面积积(rP·S)和相对提取分数(rE)来评估延迟灌注区术前血脑屏障透性。结果:术后发生出血转化22例(37.7%),其中出血性梗死10例(16.9%),实质血肿11例(20.8%)。脑实质血肿组低灌注区rP·S、rKtrans、rE均显著高于出血性梗死组和无出血转化组(p trans预测取栓后脑实质血肿转化的曲线下p·S面积[AUC] .844 vs. rKtrans AUC .753, z = 2.064, p = 0.039;rE AUC为0.907,rKtrans AUC为0.753,z = 2.399, p = 0.017)。结论:机械取栓后脑实质血肿患者在低灌注区具有较高的血脑屏障通透性。在血脑屏障通透性测量参数中,rP·S和rE对脑实质血肿的预测精度较高。
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来源期刊
Journal of Neuroimaging
Journal of Neuroimaging 医学-核医学
CiteScore
4.70
自引率
0.00%
发文量
117
审稿时长
6-12 weeks
期刊介绍: Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!
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