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Radiology:遇到急性缺血性卒中患者时,一定要看看有没有这些征象!

2021-11-20 shaosai MedSci原创

在急性缺血性卒中的患者中,阻塞的血管导致供血区域脑组织的氧气供应不足。

在急性缺血性卒中的患者中,阻塞的血管导致供血区域脑组织的氧气供应不足。在这种情况下,脑组织是否以及何时发展为梗死取决于许多因素,包括组织类型(灰质与白质)、缺血时间和严重程度、病人年龄和原有的合并症。似乎符合逻辑的是,更广泛的组织损伤与不良的功能预后有关;换句话说,人们认为梗死面积更大的患者预后会更差。的确,许多大面积脑梗塞的病人预后不佳,但有些病人却预后较好,而另一些脑梗塞较小的病人则出现严重残疾。除了整体大小之外,梗死的位置也是决定结果的重要因素。例如,脉络膜前动脉区域的梗塞面积很小。然而,尽管面积小,但它们常常影响皮质脊髓束进而导致严重残疾。

迄今为止,人们对有关梗死模式和位置的预后相关性了解甚少近日,发表在Radiology杂志的一项研究分析了24小时随访的平扫CT和弥散加权MRI所看到的定性和定量的梗死变量,探讨了梗死模式和组织特定的梗死体积对临床预后的影响为临床对急性卒中患者预后的早期诊断估及治疗评估提供了参考依据

ESCAPE-NA1随机对照试验在2017年3月1日至2019年8月12日期间招募了接受机械血栓切除术的大血管闭塞型卒中患者。在项试验的事后分析中,在24小时随访的平扫CT或弥散加权MRI上评估了梗死的定性变量(主要是灰质[与灰白质]受累,皮质脊髓束受累,梗死结构[散在与区域性])和总梗死体积。患者的白质和灰质梗死体积是通过后续扩散加权MRI评估的。梗塞变量在有和没有良好预后的患者之间进行比较,良好预后定义为90天时改良的Rankin量表评分为0-2。使用多变量逻辑回归确定梗死变量与良好预后的关系。使用单独的回归模型来报告对总梗死体积进行调整后的效应大小估计。

对1026名患者(平均年龄±标准差,69岁±13岁;522名男性)进行了定性梗死变量评估,对1026名患者中的358名亚组(平均年龄,67岁±13岁;190名女性)进行了定量梗死变量评估。灰质和白质受累(多变量调整后的几率[OR],0.19;95%CI:0.14,0.25;P < .001)皮质脊髓束受累(多变量调整后的OR,0。 06; 95% CI: 0.04, 0.10; P < .001),区域性梗死(多变量调整后的OR,0.22; 95% CI: 0.14, 0.32; P < .001)的患者预后较差与总梗死体积无关

 不同梗死体积(大于或等于x轴上显示的体积)的90天内预后良好的累积比例。黑线代表整体梗死体积,绿线代表灰质梗死体积,蓝线代表白质梗死体积。

综上所述,在本项接受机械血栓切除术的大血管闭塞导致的急性缺血性卒中患者样本中,分散的梗死结构、皮质脊髓束回避以及梗死局限在灰质的情况都能高度预测预后良好,与总梗死体积无关。除总梗死体积外,进一步评估梗死的定性和定量变量改善急性缺血性卒中患者的预后。

原文出处

Johanna M Ospel,Bijoy K Menon,Wu Qiu,et al.A Detailed Analysis of Infarct Patterns and Volumes at 24-hour Noncontrast CT and Diffusion-weighted MRI in Acute Ischemic Stroke Due to Large Vessel Occlusion: Results from the ESCAPE-NA1 Trial.DOI:10.1148/radiol.2021203964

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    2021-11-24 靝韔埊鬏

    整挺好👍👍👍

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2010443, encodeId=d8c2201044368, content=<a href='/topic/show?id=9cf7e9360d2' target=_blank style='color:#2F92EE;'>#缺血性卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79360, encryptionId=9cf7e9360d2, topicName=缺血性卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Mon Jan 31 15:36:50 CST 2022, time=2022-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893447, encodeId=8bd9189344e34, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Thu Jul 14 19:36:50 CST 2022, time=2022-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720431, encodeId=bb1e1e204319f, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Mon Feb 21 22:36:50 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806476, encodeId=070118064e6b2, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Mon May 02 05:36:50 CST 2022, time=2022-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1073472, encodeId=d88210e34721c, content=整挺好👍👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=927a5571807, createdName=靝韔埊鬏, createdTime=Wed Nov 24 10:37:47 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072436, encodeId=b22510e243678, content=两个120。, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cbcd5675699, createdName=moyanju2796, createdTime=Sun Nov 21 08:58:23 CST 2021, time=2021-11-21, status=1, ipAttribution=)]
    2021-11-21 moyanju2796

    两个120。

    0

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