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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >White Matter Hypoperfusion Associated with Leukoaraiosis Predicts Intracranial Hemorrhage after Intravenous Thrombolysis
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White Matter Hypoperfusion Associated with Leukoaraiosis Predicts Intracranial Hemorrhage after Intravenous Thrombolysis

机译：白质低血灌注与菌落病相关，预测静脉溶栓后颅内出血

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Objectives: White matter hyperintensity is common in patients receiving intravenous thrombolysis. Some studies have expressed concern about the increased risk of hemorrhagic transformation and poor prognosis for those patients with pre-existing leukoaraiosis. The purpose of this study was to evaluate hypoperfusion associated with leukoaraiosis before thrombolysis using CT perfusion and to explore whether chronic white matter hypoperfusion increases risks of intracranial hemorrhage and poor clinical prognosis. Materials and Methods: We collected 175 patients underwent intravenous thrombolysis with complete CT perfusion data and follow-up MRI between June 2017 and January 2020. We measured cerebral blood flow, cerebral blood volume, mean transit time and transit time to the peak at both periventricular and subcortical layers in the cerebral hemisphere contralateral to the stroke. The differences of white matter perfusion were compared between groups with different leukoaraiosis severity. Univariate analysis was used to compare in incidence of hemorrhagic transformation and poor prognosis between the hypoperfusion and normal perfusion groups. Further, we examined association between white matter hypoperfusion and intracranial hemorrhage after thrombolysis using logistic regression. Results: The length of periventricular transit time to the peak was independently associated with a higher risk of intracranial hemorrhage after thrombolysis (OR=4.740, 95%CI=1.624-13.837, P=0.004). The best predictive value was 4.012. But there was no significant difference in poor prognosis at 3 months between hypoperfusion (periventricular transit time to the peak >= 4.012 s) and normal perfusion (periventricular transit time to the peak<4.012 s) group. Conclusions: Image presentations of white matter hypoperfusion reflected the severity of leukoaraiosis. White matter hypoperfusion was independently associated with intracranial hemorrhage after intravenous thrombolysis. However, hypoperfusion would not increase the risk of poor prognosis.
机译：目的：白质高信号在接受静脉溶栓治疗的患者中很常见。一些研究对已有脑白质疏松症的患者出血转化风险增加和预后不良表示担忧。本研究的目的是在CT灌注溶栓前评估与脑白质疏松症相关的低灌注，并探讨慢性脑白质低灌注是否会增加颅内出血风险和不良临床预后。材料和方法：我们收集了2017年6月至2020年1月期间175例接受静脉溶栓治疗的患者的完整CT灌注数据和随访MRI。我们测量了中风对侧大脑半球脑室周围层和皮质下层的脑血流量、脑血容量、平均转运时间和峰值转运时间。比较不同脑白质疏松严重程度组之间白质灌注的差异。单变量分析用于比较低灌注组和正常灌注组的出血转化率和不良预后。此外，我们还使用logistic回归分析了溶栓后白质低灌注和颅内出血之间的关系。结果：到达峰值的室周转运时间长度与溶栓后颅内出血的高风险独立相关（OR=4.740，95%CI=1.624-13.837，P=0.004）。最佳预测值为4.012。但低灌注组（心室周围转运时间达到峰值>=4.012s）和正常灌注组（心室周围转运时间达到峰值<4.012s）在3个月时预后不良方面没有显著差异。结论：脑白质灌注不足的影像表现反映了脑白质疏松症的严重程度。白质灌注不足与静脉溶栓后颅内出血独立相关。然而，低灌注不会增加预后不良的风险。

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