Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index.

Autor: Salim H; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA., Lakhani DA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Balar A; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Musmar B; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA., Adeeb N; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA., Hoseinyazdi M; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Luna L; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Deng F; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Hyson NZ; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Mei J; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Dmytriw AA; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.; Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada., Guenego A; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium., Faizy TD; Department of Radiology, Neuroendovascular Program, University Medical Center, Münster, Germany., Heit JJ; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA., Albers GW; Department of Neurology, Stanford Medical Center, Palo Alto, CA, USA., Urrutia VC; Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA., Llinas R; Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA., Marsh EB; Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA., Hillis AE; Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA., Nael K; University of California San Francisco, San Francisco, CA, USA., Yedavalli V; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. vyedava1@jhmi.edu.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2024 Jun; Vol. 271 (6), pp. 3389-3397. Date of Electronic Publication: 2024 Mar 20.
DOI: 10.1007/s00415-024-12279-3
Abstrakt: Background: Distal medium vessel occlusions (DMVOs) contribute substantially to the incidence of acute ischemic strokes (AIS) and pose distinct challenges in clinical management and prognosis. Neuroimaging techniques, such as Fluid Attenuation Inversion Recovery (FLAIR) imaging and cerebral blood volume (CBV) index derived from perfusion imaging, have significantly improved our ability to assess the impact of strokes and predict their outcomes. The primary objective of this study was to investigate relationship between follow-up infarct volume (FIV) as assessed by FLAIR imaging in patients with DMVOs.
Methods: This prospectively collected, retrospective reviewed cohort study included patients from two comprehensive stroke centers within the Johns Hopkins Medical Enterprise, spanning August 2018-October 2022. The cohort consisted of adults with AIS attributable to DMVO. Detailed imaging analyses were conducted, encompassing non-contrast CT, CT angiography (CTA), CT perfusion (CTP), and FLAIR imaging. Univariable and multivariable linear regression models were employed to assess the association between different factors and FIV.
Results: The study included 79 patients with DMVO stroke with a median age of 69 years (IQR, 62-77 years), and 57% (n = 45) were female. There was a negative correlation between the CBV index and FIV in a univariable linear regression analysis (Beta =  - 16; 95% CI,  - 23 to  - 8.3; p < 0.001) and a multivariable linear regression model (Beta =  - 9.1 per 0.1 change; 95% CI,  - 15 to  - 2.7; p = 0.006). Diabetes was independently associated with larger FIV (Beta = 46; 95% CI, 16 to 75; p = 0.003). Additionally, a higher baseline ASPECTS was associated with lower FIV (Beta =  - 30; 95% CI,  - 41 to  - 20; p < 0.001).
Conclusion: Our findings underscore the CBV index as an independent association with FIV in DMVOs, which highlights the critical role of collateral circulation in determining stroke outcomes in this patient population. In addition, our study confirms a negative association of ASPECTS with FLAIR FIV and identifies diabetes as independent factor associated with larger FIV. These insights pave the way for further large-scale, prospective studies to corroborate these findings, thereby refining the strategies for stroke prognostication and management.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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