Amide Proton Transfer-Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-03-01 DOI:10.1002/jmri.29333

Le Zhou MS, Wanqian Pan MS, Renjun Huang MD, Tianye Wang MS, Zifan Wei MS, Hui Wang MD, Yi Zhang PhD, Yonggang Li MD

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Abstract

Background

The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer-weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment.

Purpose

To utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90-day prognosis in patients diagnosed with ischemic stroke.

Study Type

Prospective.

Subjects

61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study.

Field Strength/Sequence

3T/turbo spin echo (TSE) T₁-weighted imaging, T₂-weighted imaging, T₂-fluid attenuated inversion recovery (T₂-FLAIR), diffusion-weighted imaging (DWI), and single-shot TSE APTw imaging.

Assessment

APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model.

Statistical Tests

Kolmogorov–Smirnov test, t-test, Mann–Whitney U test, chi-square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05.

Results

Correlation analysis revealed that APTw and NIHSS exhibit the highest correlation (r = −0.634, 95% confidence interval [CI] −0.418 to −0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845–0.970), ADC (OR 0.745, 95% CI 0.609–0.911), and infarct core-cerebral blood volume (IC-CBV) (OR 0.547, 95% CI 0.310–0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911–0.988), exceeding that of APTw, ADC, and IC-CBV individually.

Data Conclusion

The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies.

Level of Evidence

Technical Efficacy

Stage 2

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酰胺质子转移加权磁共振成像与缺血性脑卒中的临床严重程度和预后的关系。

背景：美国国立卫生研究院脑卒中量表（NIHSS）和改良Rankin量表（mRS）评分存在重大缺陷。目的：利用酰胺质子转运加权成像（APTw）、表观弥散系数（ADC）和计算机断层扫描灌注成像（CTP）评估缺血性脑卒中患者的临床症状严重程度和 90 天预后：研究类型：前瞻性：研究对象：61 名缺血性脑卒中患者（平均年龄 63.2 ± 9.7 岁；46 名男性，15 名女性）：3T/涡旋回波（TSE）T1加权成像、T2加权成像、T2流体衰减反转恢复（T2-FLAIR）、弥散加权成像（DWI）和单发TSE APTw成像：采用 APTw、ADC 和 CTP 对患者亚组进行比较，并构建预后提名图模型：Kolmogorov-Smirnov检验、t检验、Mann-Whitney U检验、卡方检验、Pearson相关分析、多变量逻辑回归分析、决策曲线分析（DCA）、接收器操作特征曲线（ROC）。显著性阈值设定为 P 结果：相关性分析显示，APTw 与 NIHSS 的相关性最高（r = -0.634，95% 置信区间 [CI] -0.418--0.782），超过了 ADC 与病变大小的相关性。多变量分析显示，APTw（几率比 [OR] 0.905，95% CI 0.845-0.970）、ADC（OR 0.745，95% CI 0.609-0.911）和梗死核心-脑血量（IC-CBV）（OR 0.547，95% CI 0.310-0.964）是与不良预后相关的潜在风险因素。提名图模型的预测效力最高，其曲线下面积（AUC）为 0.960（95% CI 0.911-0.988），超过了 APTw、ADC 和 IC-CBV 的单独预测效力：数据结论：APTw 技术在缺血性中风患者的分类和管理方面具有潜在价值，可为临床治疗策略的实施提供指导：1 技术疗效：第 2 阶段。

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