The rCBV Ratio Is a Predictive Factor for Developing Malignant Middle Cerebral Artery Infarction within 6 Hours of Symptom Onset
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Background: Malignant middle cerebral artery (MCA) infarction is one of the leading cause of death for patients with acute MCA infarction. We investigated the predicting factors for developing malignant MCA infarction (MMI) using multi-parametric magnetic resonance imaging (MRI). Methods: We included 159 MCA infarction patients who visited Dong-A University Stroke Center from January 2007 to December 2010 and were diagnosed MCA occlusion within 6 hours after symptom onset. All patients underwent brain MRI including diffusion and perfusion-weighted image. The definition of the malignant MCA infarction is as follows: 1) deterioration of neurological symptoms and consciousness with clinical signs of uncal herniation, and 2)at least two-thirds of the MCA territory with compression of ventricles or midline shifting. The neurological deterioration was observed for 7 days. The severity of neurological symptom and clinical outcome were assessed by using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Among 159 patients, 49 patients (30.8%) developed MMI. In a multivariate analysis, a larger diffusion volume on diffusion-weighted image, a lower regional cerebral blood volume (rCBV) ratio on perfusion-weighted image, and a higher NIHSS score on admission were identified as the predictive factors of MMI. The cut-off values of diffusion volume, NIHSS on admission and rCBV ratio were 69 mL, 15 points and 0.78. Conclusion:A large diffusion volume, a high NIHSS score and particularly a low rCBV ratio can predict a malignant course in MCA infarction within 6 hours of symptom onset in MCA occlusion.
Abstract
Background: Malignant middle cerebral artery (MCA) infarction is one of the leading cause of death for patients with acute MCA infarction. We investigated the predicting factors for developing malignant MCA infarction (MMI) using multi-parametric magnetic resonance imaging (MRI). Methods: We included 159 MCA infarction patients who visited Dong-A University Stroke Center from January 2007 to December 2010 and were diagnosed MCA occlusion within 6 hours after symptom onset. All patients underwent brain MRI including diffusion and perfusion-weighted image. The definition of the malignant MCA infarction is as follows: 1) deterioration of neurological symptoms and consciousness with clinical signs of uncal herniation, and 2)at least two-thirds of the MCA territory with compression of ventricles or midline shifting. The neurological deterioration was observed for 7 days. The severity of neurological symptom and clinical outcome were assessed by using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Among 159 patients, 49 patients (30.8%) developed MMI. In a multivariate analysis, a larger diffusion volume on diffusion-weighted image, a lower regional cerebral blood volume (rCBV) ratio on perfusion-weighted image, and a higher NIHSS score on admission were identified as the predictive factors of MMI. The cut-off values of diffusion volume, NIHSS on admission and rCBV ratio were 69 mL, 15 points and 0.78. Conclusion:A large diffusion volume, a high NIHSS score and particularly a low rCBV ratio can predict a malignant course in MCA infarction within 6 hours of symptom onset in MCA occlusion.
참고문헌 (29)
- del Zoppo GJ, "Recombination tissue plasminogen activator in acute thrombotic and embolic stroke", Ann Neurol, 32, pp.78~86 (1992)
- Furlan A, "Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial", JAMA, 282, pp.2003~2011 (1999)
- Tanaka M, "Chronic middle cerebral artery occlusion: a hemodynamic and metabolic study with position-emission tomography", AJNR, 29, pp.1841~1846 (2008)
- Olsen TS, "A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute state based interpreting severe hyperemia as a sign of embolic migration", Stroke, 15, pp.458~468 (1984)
- Albers GW, "DEFUSE investigators. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study", Ann Neurol, 60, pp.508~517 (2006)
- Rha JH, "The impact of recanalization on ischemic stroke outcome: a meta-analysis", Stroke, 38, pp.967~973 (2007)
- Vahedi K, "DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomized controlled trials", Lancet Neurol, 6, pp.215~222 (2007)
- Thomalla G, "Clinical Trial Net of the German Competence Network Stroke. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study", Ann Neurol, 68, pp.435~445 (2010)
- Chalela JA, "Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison", Lancet, 369, pp.293~298 (2007)
- Sorensen AG, "Hyperacute stroke: simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time", Radiology, 210, pp.519~527 (1999)
- Bivard A, "Defining the extent of irreversible brain ischemia using perfusion computed tomography", Cerebrovasc Dis, 31, pp.238~245 (2011)
- Oppenheim C, "Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging", Stroke, 31, pp.2175~2181 (2000)
- Thomalla GJ, "Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging", Stroke, 34, pp.1892~1899 (2003)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Lee SY, "Regional cerebral blood volume ratio on perfusion MRI on the growth of infarct size in acute ischemic stroke", Eur Neurol, 62, pp.281~286 (2009)
- Park HI, "Reduced rCBV ratio in perfusion-weighted MR images predicts poor outcome after thrombolysis in acute ischemic stroke", Eur Neurol, 65, pp.257~263 (2011)
- Hacke W, "DIAS Study Group. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase", Stroke, 36, pp.66~73 (2005)
- Hacke W, "ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke", N Engl J Med, 359, pp.1317~1329 (2008)
- Yoo AJ, "MRI-based selection for intra-arterial stroke therapy: value of pre-treatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization", Stroke, 40, pp.2046~2054 (2009)
- Kidwell CS, "Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion", perfusion magnetic resonance imaging, 2000, pp.47, 462~469
- Yamada K, "Magnetic resonance perfusion-weighted imaging of acute cerebral infarction: effect of the calculation methods and underlying vasculopathy", Stroke, 33, pp.87~94 (2002)
- Neumann-Haefelin T, "Diffusion- and perfusion-weighted MRI: influence of severe carotid stenosis on the DWI", PWI mismatch in acute stroke, 2003, pp.31, 1311~1317
- Liu Y, "Acute ischemic stroke: predictive value of 2D phasecontrast MR angiography--serial study with combined diffusion and perfusion MR imaging", Radiology, 231, pp.517~527 (2004)
- Bang YO, "UCLA Collateral Investigators. Impact of collateral flow on tissue fate in acute ischemic stroke", J Neurol Neurosurg Psychiatry, 79, pp.625~629 (2008)
- Darby DG, "Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI", Stroke, 30, pp.2043~2052 (1999)
- Albers GW, "Magnetic resonance imaging profiles predict clinical response to early reperfusion: the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study", Ann Neurol, 60, pp.508~517 (2006)
- Puetz V, "Malignant profile detected by CT angiographic information predicts poor prognosis despite thrombolysis within three hours from symptom onset", Cerebrovasc Dis, 29, pp.584~591 (2010)
- 오세호, "중대뇌동맥과 내경동맥 죽상경화증으로 인한 뇌졸중의 임상 및 신경방사선적 양상의 비교", 대한신경과학회지, 21(5), pp.3~467 (2003), 대한신경과학회
- Choi JW, "Angiographic pattern of symptomatic severe M1 stenosis: comparison with presenting symptoms, infarct patterns, perfusion status, and outcome after recanalization", Cerebrovasc Dis, 29, pp.297~303 (2010)