急性缺血性卒中患者溶栓治疗前后CT微血管表面通透性参数图的特点分析

摘要/Abstract

摘要：

目的分析动态计算机X线断层扫描灌注（CT perfusion，CTP）成像获得的脑组织局部微血管表面通透性（permeability surface，PS）参数图在急性缺血性卒中中的分布特点以及其在溶栓治疗前后的变化。方法急性缺血性卒中发病3～8h内的入组患者分别在基线和静脉溶栓治疗后接受“一站式”CT检查。使用Patlak模型分析CTP图像并得到PS参数图，分别测量基线和溶栓后的患侧和健侧脑组织的微血管PS值，分别记为：患侧基线PS（PSischemia-pre）、健侧基线PS（PScontrol-pre）、患侧溶栓后PS（PSischemia-post）和健侧溶栓后PS（PScontrol-post）。结果 22例患者基线时接受“一站式”CT检查以及静脉溶栓治疗，17例患者完成（24±6）h随访的CTP成像评价。患者的基线PS值患侧较对侧升高[6.20ml・min-1・（100ml）-1 vs 0.65ml・min-1・（100ml）-1，P<0.01]；溶栓治疗后PS值患侧仍较健侧为高[3.39ml・min-1・（100ml）-1 vs 0.39ml・min-1・（100ml）-1，P<0.01]。基线以及溶栓后患侧和健侧PS定量值均具有统计学差异（P<0.01）。17例基线和随访CTP均可评估的数据中，13例（76％）患者溶栓治疗后PS值降低，但患侧基线和溶栓治疗后PS值差异无统计学意义（P＝0.093）。22例患者中1例发生出血转化，其PSischemia-pre为6.74ml・min-1・（100ml）-1。结论动态CTP成像获得的PS参数图可以用来反映急性缺血性脑组织缺血区域的通透性异常增高。

关键词: 脑梗死; 血栓溶解疗法; 通透性; CT灌注成像

Abstract:

Objective To determine the microvascular permeability surface(PS) area product in acute ischemic stroke using dynamic computed tomography perfusion(CTP) and to analyze the characteristics before and after thrombolytic therapy. Methods According to inclusion criteria, the selected patients underwent a baseline “One Stop Shop” computed tomography(CT) examination within 3-8 hours of onset of symptoms and a follow-up study after they accepted rt-PA treatment. The Patlak model was applied to generate PS color maps from CTP. One radiologist analyzed each PS map by drawing 4 circular regions of interest(ROI) on hypoperfusion area that was in charge of the onset, and mirror regions of interest were automatically placed on the contralateral nonischemic hemisphere. According to the median of the 4 ROI, baseline PS(PSischemia-pre and PScontrol-pre) and follow-up PS(PSischemia-post and PScontrol-post) were obtained, respective. PSischemia-pre and PScontrol-pre, PSischemia-post and PScontrol-post, PSischemia-pre and PSischemia-post were compared by using an exact Wilcoxon test. Results Twenty-two patients were evaluated by baseline CTP and seventeen patients completed the follow-up CTP evaluation. Seventeen patients(77%) showed focal PS elevation in the region of infact. PSischemia-pre ranged from 1.28 to 29.36ml•min-1•(100ml)-1(median: 6.20) versus PScontrol-pre of 0 to 4.29(0.65; P<0.01), PSischemia-post of 0.54 to 12.15(3.39) versus PScontrol-post of 0 to 4.44(0.39; P<0.01). And the difference between PSischemia-pre and PSischemia-post was no significant(Z=-1.681, P=0.093). One of these twenty-two patients developed hemorrhagic transformation(HT) on follow-up imaging and the PSischemia-pre was 6.74ml•min-1•(100ml)-1. Conclusion Elevated permeability can be detectable in acute ischemic stroke by using dynamic CTP.

Key words: Brain infarction; Thrombolytic theraphy; Permeability; CT perfusion imaging

薛静;高培毅;林燕. 急性缺血性卒中患者溶栓治疗前后CT微血管表面通透性参数图的特点分析[J]. 中国卒中杂志, 2009, 4(09): 708-714.

XUE Jing;GAO Pe-Yi;LIN Yan. Analysis of Microvascular Permeability Surface in Acute Ischemic Stroke Before andAfter Thrombolytic Therapy Using CT Perfusion Imaging[J]. Chinese Journal of Stroke, 2009, 4(09): 708-714.

参考文献

1 The National Institute of Neurological Disorders and

Stroke rt-PA Stroke Study Group. Tissue plasminogen

activator for acute ischemic stroke[J]. N Engl J Med,

1995, 333:1581-1587.

2 Furlan A, Higashida R, Wechsler L, et al. Intraarterial

prourokinase for acute ischemic stroke. The

PROACT Ⅱ study: a randomized controlled trial.

Prolyse in Acute Cerebral Thromboembolism[J].JAMA, 1999, 282:2003-2011.

3 Kassner A, Roberts T, Taylor K, et al. Prediction

of hemor rhage in acute ischemic st roke using

p e rme a b i l i t y MR ima g i n g [ J ] . AJ NR Am J

Neuroradiol, 2005, 26:2213-2217.

4 Castellanos M, Leira R, Serena J, et al. Plasma

me t a l loprot e i n a s e -9 c onc e nt r a t ion pr e d ic t s

hemor rhagic t ransformation in acute ischemic

stroke[J]. Stroke, 2003, 34:40-46.

5 Montaner J, Molina CA, Monasterio J, et al. Matrix

metalloproteinase-9 pretreatment level predicts

int racranial hemor rhagic complicat ions af ter

thrombolysis in human stroke[J]. Circulation, 2003,

107:598-603.

6 Wi nt e rma rk M, Meu l i R, Browa eys P, e t a l .

Comparison of CT perfusion and angiography and

MRI in selecting stroke patients for acute treatment[J].

Neurology, 2007, 68:694-697.

7 Li n K, Ka zmi KS, Law M, et a l. Me a su r i ng

Elevated Microvascular Permeability and Predicting

Hemorrhagic Transformation in Acute Ischemic

St roke Usi ng Fi r s t-Pa s s Dy namic Pe r f u sion

CT Imaging[J]. AJNR Am J Neuroradiol, 2007,

28:1292-1298.

8 Miles KA, Kelley BB. CT measurements of capillary

permeability within nodal masses: a potential

technique for assessing the activity of lymphoma[J].

Br J Radiol, 1997, 70:74-79.

9 Yang S, Law M, Zagzag D, et al. Dynamic contrastenhanced

perfusion MR imaging measurements of

endothelial permeability: differentiation between

atypical and typical meninggiomas[J]. AJNR Am J

Neuroradiol, 2003, 24:1554-1559.

10 Roberts HC, Roberts TP, Brasch RC, et al. Quantitative

measurement of microvascular permeability in

human brain tumors achieved using dynamic contrastenhanced

MR iminging: correlation with histologic

grade[J]. AJNR Am J Neuroradiol, 2000, 21:891-899.

11 Belayev L, Busto R, Zhao W, et al. Quantitative

evaluation of blood-brain bar rier permeability

following middle cerebral artery occlusion in rats[J].

Brain Res, 1996, 739:88-96.

12 Latour LL, Kang DW, Ezzeddine MA, et al. Early

blood-brain barrier disruption in human focal brain

ischemia[J]. Ann Neurol, 2004, 56:468-477.

13 Khatri P, Wechsler LR, Broderick JP. Intracranial

hemor rhage associated with revascular ization

therapies[J]. Stroke, 2007, 38:431-440.

14 Gasche Y, Copin JC, Sugawara T, et al. Matrix

metalloproteinase inhibition prevents oxidative

stress-associated blood-brain barrier disruption after transient focal cerebral ischemia[J]. J Cereb Blood

Flow Metab, 2001, 21:1393-1400.

15 Belayev L, Busto R, Zhao W, et al. Quantitative

evaluation of blood brain bar rier permeability

following middle cerebral artery occlusion in rats[J].

Brain Res, 1996, 739:88-96.

16 Ribo M, Montaner J, Molina CA, et al. Admission

fibrinolytic profile is associated with symptomatic

hemorrhagic transformation in stroke patients treated

with tissue plasminogen activator[J]. Stroke, 2004,

35:2123-2127.

17 Castellanos M, Leira R, Serena J, et al. Plasma

c e l lu l a r-f ib rone c t i n c onc e nt r a t ion p r e d i c t s

hemor rhagic transformation after thrombolytic

therapy in acute ischemic stroke[J]. Stroke, 2004,

35:1671-1676.

18 Warach S, Latour LL. Evidence of reperfusion injury,

exacerbated by thrombolytic therapy, in human focal

brain ischemia using a novel imaging marker of

early blood-brain barrier disruption[J]. Stroke, 2004,

35:2659-2661.

19 Selim M, Fink JN, Kumar S, et al. Predictors of

hemor rhagic t ransformation af ter int ravenous

recombinant tissue plasminogen activator: prognostic

value of the initial apparent diffusion coefficient and

diffusion-weighted lesion volume[J]. Stroke, 2002,

33:2047-2052.

20 Schwamm LH, Rosenthal ES, Swap CJ, et al.

Hypoattenuation on CT angiographic source images

predicts risk of intracerebral hemorrhage and outcome

after intra-arterial reperfusion therapy[J]. AJNR Am

J Neuroradiol, 2005, 26:1798-1803.

[1]	李如娟, 杨川, 马晓辉, 侯焕峰, 付会杰, 马晓丹, 方军涛, 靳金灵, 杨金波. DSA评估无症状大脑中动脉闭塞患者侧支循环状态研究 [J]. 中国卒中杂志, 2022, 17(12): 1355-1359.
[2]	胡红梅, 杨磊, 于玲, 秦伟, 白明悦, 胡文立. 急性单发小脑小梗死的临床特征 [J]. 中国卒中杂志, 2022, 17(11): 1221-1226.
[3]	刘亚杰, 李玉娣, 黎凯锋, 陈哲锋, 凌莉. 基于高通量RNA-Seq技术探讨补阳还五汤治疗小鼠脑梗死的作用机制 [J]. 中国卒中杂志, 2022, 17(11): 1238-1246.
[4]	王磊, 周春亭, 方洋, 王朝晖. 2例椎动脉漂浮血栓的治疗体会[J]. 中国卒中杂志, 2022, 17(11): 1247-1251.
[5]	林庆金, 杨雅玲, 卢武生. 寰椎变异致反复脑梗死1例报道[J]. 中国卒中杂志, 2022, 17(11): 1252-1256.
[6]	罗秋雁, 黄文利, 冯慧宇, 陈玲, 周鸿雁. 脑室出血合并大面积脑梗死1例报道并文献复习[J]. 中国卒中杂志, 2022, 17(10): 1103-1107.
[7]	杨金波, 张英魁. 到底应该用面积还是用体积描述梗死病灶？[J]. 中国卒中杂志, 2022, 17(10): 1112-1113.
[8]	何俊芳, 刘新平, 吕学海, 王斌. PI3K/AKT信号通路介导脂联素对脑缺血再灌注大鼠的保护作用 [J]. 中国卒中杂志, 2022, 17(08): 857-862.
[9]	闫志杰, 曲庆明, 张淇, 张永丽, 樊启为, 吕海东, 贾杰. 缺血性卒中患者基于心肺适能个体化训练1例报告[J]. 中国卒中杂志, 2022, 17(06): 585-588.
[10]	徐冉, 李悦悦, 冯凡凡, 阚伟豪, 董瑞国. 肺癌相关脑梗死的危险因素分析[J]. 中国卒中杂志, 2022, 17(06): 628-633.
[11]	仲伟斌, 王鹏飞, 于进超, 张金彪, 李振光. 支架治疗颈动脉夹层导致急性脑梗死2例报告及文献复习[J]. 中国卒中杂志, 2022, 17(06): 653-657.
[12]	李婛, 黄燕兰, 钟一飞, 郭晓云. 以偏侧肢体舞蹈样动作为脑梗死首发症状的Trousseau综合征1例并文献分析[J]. 中国卒中杂志, 2022, 17(05): 535-538.
[13]	李言洵, 刘芳, 王丽, 汪慧, 何雯. 多发性脑梗死起病的噬血细胞综合征1例报道[J]. 中国卒中杂志, 2022, 17(05): 539-543.
[14]	杨卜凡, 邹新宇, 龚小沉, 都泓材, 陈忠伦, 唐宇凤, 李肇坤. 反应性红细胞增多症伴大脑前动脉夹层动脉瘤致脑梗死1例[J]. 中国卒中杂志, 2022, 17(03): 310-313.
[15]	赵义. 困局与破局：聚焦大动脉炎并发脑梗死[J]. 中国卒中杂志, 2021, 16(12): 1199-1202.