CT Perfusion imaging as prognostic factor for outcome of lacunar stroke.

IF 2.4 3区医学 Q2 CLINICAL NEUROLOGY Neuroradiology Pub Date : 2024-12-01 Epub Date: 2024-10-10 DOI:10.1007/s00234-024-03480-2

Stefan Mausbach, Lamya Ahmad Abdallah, Eliel Ben-David, Michael Teitcher, Natan M Bornstein, Roni Eichel

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Abstract

Background: Early neurological deterioration (END) affects 20-30% of patients with lacunar stroke within 48 h despite optimal treatment. Previously established markers included infection and infarct location on imaging. We studied the utility of measuring global cerebral blood flow (gCBF) measured by CT-Perfusion (CTP) as an early predictor of END in patients with lacunar strokes.

Methods: 162 patients with lacunar stroke were measured for gCBF including both cerebral hemispheres and cerebellum. We stratified patients by normal gCBF (> 40 ml/100 mg/min) vs. low gCBF (< 40 ml/100 mg/min). Stroke location, vascular risk factors, age and gender were assessed. The primary outcome was the change in the NIHSS score after 48 h from index stroke.

Results: Mean gCBF of the overall cohort was 37.72 ml/100 mg/min. Both groups had a baseline NIHSS score of 4.2 with similar standard deviations. The NIHSS score decreased by 1.3 points in normal gCBF group and increased by 1.1 points in the low gCBF group. All stroke sites deteriorated in the low gCBF group, particularly the capsula interna, corona radiata, and lateral pontine area. END occurred in 37.8% in low gCBF compared to 3.1% in the normal gCBF patients. In contrast, clinical improvement after 48 h occurred in 64.2% of patients with normal gCBF but only 6.1% with low gCBF.

Conclusion: Our study supports measurement of gCBF by CTP as a potential imaging biomarker for END. Additionally, it adds evidence to the body of supporting the vulnerability of capsula interna and pontine infarctions to END.

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作为腔隙性中风预后因素的 CT 灌注成像。

背景：尽管接受了最佳治疗，但仍有 20%-30% 的腔隙性中风患者会在 48 小时内出现早期神经功能恶化（END）。以前确定的标志物包括感染和影像学上的梗死位置。方法：162 名腔隙性脑卒中患者接受了包括大脑半球和小脑在内的 gCBF 测量。我们按照正常 gCBF（大于 40 毫升/100 毫克/分钟）与低 gCBF 对患者进行了分层（结果：162 名腔隙性脑卒中患者的平均 gCBF 为 40 毫升/100 毫克/分钟）：总体组群的平均 gCBF 为 37.72 毫升/100 毫克/分钟。两组患者的基线 NIHSS 评分均为 4.2，标准差相似。正常 gCBF 组的 NIHSS 评分下降了 1.3 分，低 gCBF 组则上升了 1.1 分。低 gCBF 组所有卒中部位均恶化，尤其是腹腔内囊、放射冠和外侧桥脑区。低 gCBF 组发生 END 的比例为 37.8%，而正常 gCBF 组为 3.1%。相比之下，64.2%的正常 gCBF 患者在 48 小时后临床症状有所改善，而低 gCBF 患者仅有 6.1%：我们的研究支持将 CTP 测量 gCBF 作为潜在的END 影像生物标志物。结论：我们的研究支持将 CTP 测量 gCBF 作为END 的潜在成像生物标志物，此外，它还为支持囊间和桥脑梗死易受END 影响的证据增添了新的内容。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.