脑梗死后出血性转化是与急性缺血性卒中相关的最常见的不良事件之一,影响到治疗方案和临床预后评价。本文总结了不同的影像学方法和影像学生物标志物,包括计算机断层扫描、磁共振成像、血管造影成像等方法在预测HT方面的作用,同时也包括不同的影像学生物标志物指标,如早期缺血改变、大的缺血病灶体积、严重的血流受限情况、血脑屏障破坏、不良的侧支循环形成和血流速度高等都与HT风险相关。
Hemorrhagic transformation is one of the most common adverse events associated with acute is-chemic stroke, which affects treatment and clinical prognosis. This paper summarizes the role of different imaging methods and imaging biomarkers, including computed tomography, magnetic resonance imaging and angiography in predicting HT, as well as different imaging biomarker indi-cators. For example, early ischemic changes, large ischemic lesion volume, severe blood flow re-striction, destruction of blood-brain barrier, poor collateral circulation formation and high blood flow velocity are all associated with the risk of HT.
Received: Jul. 24th, 2022; accepted: Aug. 19th, 2022; published: Aug. 26th, 2022
ABSTRACT
Hemorrhagic transformation is one of the most common adverse events associated with acute ischemic stroke, which affects treatment and clinical prognosis. This paper summarizes the role of different imaging methods and imaging biomarkers, including computed tomography, magnetic resonance imaging and angiography in predicting HT, as well as different imaging biomarker indicators. For example, early ischemic changes, large ischemic lesion volume, severe blood flow restriction, destruction of blood-brain barrier, poor collateral circulation formation and high blood flow velocity are all associated with the risk of HT.
Jang [14] 等发现AIS血管内治疗后颅内碘对比剂外渗区域存在出血风险,且病灶密度越高出血几率越大。相对传统CT,DECT重组获得的碘图可以直接测量碘对比剂外渗区域的碘浓度,对碘外渗程度进行量化。在本研究中,病灶的最大碘浓度以2.7 mg I/ml为阈值预测发生HT的敏感度为73.7%,特异度92.5%,提示机械取栓术后颅内高碘浓度区域其BBB破坏及血管内皮细胞损伤较为严重,存在HT的可能性较低碘浓度区域大,DECT不仅可以早期准确诊断AIS机械取栓术后是否合并颅内出血,而且对预测HT有一定的价值。
DSA是一种有创伤性的检查,可清楚的显示动脉管腔狭窄、闭塞、侧支循环建立情况等以及预测HT。在最近的一项研究中 [34],作者指出DSA可以预测HT,他前瞻性地分析了35名因心肌梗塞导致的AIS患者,缺血性病变由DWI进行评分,血流灌注状态是用ASL评估,早期静脉充盈是通过DSA评估的,结果显示,再灌注治疗后,35名患者中有22名(66%)观察到早期静脉填充。早期静脉充盈与DWI-ASPECTS (6.2 vs 8.8, P = 0.0003)、过度灌注(17 vs 1, P < 0.001)、HT (17 vs 1, P = 0.005)之间存在显著的相关性。这项综合研究显示,再灌注治疗后的早期静脉充盈与术后过度灌注有关。早期静脉充盈可能是高灌注过程的一个标志,导致出血和不利预后。检测早期静脉充盈可能是DSA上的一个重要发现,以便随后加强围手术期管理。
李宝娜,张庆欣. 多模态影像学预测脑梗死后出血性转化的研究进展Research Progress of Multi-Modal Imaging in Predicting Hemorrhagic Transformation af-ter Ischemic Stroke[J]. 临床医学进展, 2022, 12(08): 7911-7918. https://doi.org/10.12677/ACM.2022.1281140
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