磁共振成像预测脑缺血溶栓后症状性出血的变化

磁共振成像预测脑缺血溶栓后症状性出血的变化。

Caparros F等神经病学杂志2020年4月

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摘要


研究背景和目的通过CT扫描确定了静脉注射重组组织型纤溶酶原激活剂（rt PA）后脑缺血症状性出血转化（s-HT）的预测因素。我们评估了磁共振成像是否能识别其他的预测因子。

方法我们分析了一组连续接受静脉注射rt-PA治疗的患者在基线MRI检查后出现脑缺血的s-HT预测因子。考虑到曲线下面积（AUC）为0.70或更高，我们使用接收器工作特性曲线来表示可接受的区分。

结果944例患者中，49例（5.2%）出现s-HT。与s-HT独立相关的临床因素有：年龄（调整后或（adjOR）1.03，1年增加；95%CI 1.01～1.05）、过量饮酒（adjOR 3.13；95%CI 1.32～7.42）、近期短暂性脑缺血发作（adjOR 2.88；95%CI 1.04～7.95）和基线国立卫生研究院卒中量表评分（adjOR 1.06，1年增加）点增长；95% 置信区间1.02至1.10）。磁共振成像的预测因子是血管高强度（adjOR 3.89；95%可信区间1.50～10.08）、陈旧性梗死（adjOR 2.01；95%可信区间1.11～3.66）和弥散加权成像（DWI）体积异常（adjOR 1.02，cm3增加；95%可信区间1.01～1.03）。唯一可接受的鉴别变量是DWI异常体积（AUC 0.72；95%可信区间0.64～0.79），4 cm3预测s-HT的敏感性为78%，特异性为58%。只有核磁共振才能评估的变量不能预测s-HT。

结论虽然DWI异常体积可预测s-HT，但其他只能用MRI评价的影像学特征与s-HT无明显相关性。试验注册号NCT01614080。

Use of MRI to predict symptomatic haemorrhagic transformation after thrombolysis for cerebral ischaemia.
Caparros F,et al J Neurol Neurosurg Psychiatry 2020 Apr
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Abstract 翻译

BACKGROUND AND OBJECTIVE Predictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors.
METHOD We analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination.
RESULTS Of 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm3 increase; 95% CI 1.01 to 1.03). The only variable with an acceptable discrimination was volume of DWI abnormality (AUC 0.72; 95% CI 0.64 to 0.79), a value of 4 cm3 predicting s-HT with a 78% sensitivity and 58% specificity. Variables that can be assessed only with MRI did not predict s-HT.
CONCLUSION Although the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT. Trial registration number NCT01614080.