急性缺血性卒中患者 MR SWI-DWI 不匹配的半影量化及其与 MR ASL PWI-DWI 不匹配的比较,NMR in Biomedicine

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急性缺血性卒中患者 MR SWI-DWI 不匹配的半影量化及其与 MR ASL PWI-DWI 不匹配的比较
NMR in Biomedicine ( IF 2.7 ) Pub Date : 2021-04-20 , DOI: 10.1002/nbm.4526
Rupsa Bhattacharjee _{1,

2} , Rakesh Kumar Gupta ₃ , Biplab Das _{4,

5} , Vijay Kant Dixit ₄ , Praveen Gupta ₅ , Anup Singh _{1,

6}

Affiliation

在急性缺血性中风患者中，半影评估在治疗结果中起着重要作用。MR 灌注加权成像 (PWI) 和弥散加权成像 (DWI) 失配比可以提供半影评估。最近报道的研究表明磁敏感加权成像 (SWI) 在半影的定性评估中的潜力。我们假设使用 SWI-DWI 进行定量半影评估可以替代 PWI-DWI 方法，这也可以减少整体扫描时间。本研究的目的是开发一个使用 SWI-DWI 准确定量评估半影的框架，并使用基于 PWI-DWI 的量化对其进行验证。在目前的研究中，动脉自旋标记 (ASL) 技术已用于 PWI。这项回顾性研究包括 25 名急性缺血性中风患者，这些患者在最后一次记录的中风发作基线状况后 24 小时内就诊。11 名患者还在 48 小时内进行了 MRI 随访。MRI 采集包括 DWI、SWI、伪连续 ASL (pCASL)、FLAIR 和非对比血管造影序列。开发了一个框架来增强显着的低强度静脉体征，然后自动分割 SWI 半影 ROI。计算表观扩散系数 (ADC) 图和脑血流 (CBF) 图。来自 ADC 图的梗塞核心 ROI 和来自 CBF 图的 ASL 半影 ROI 被半自动分割。计算梗塞核心体积、SWI 半影体积 (SPV) 和 pCASL 半影体积并用于计算错配率 11 名患者还在 48 小时内进行了 MRI 随访。MRI 采集包括 DWI、SWI、伪连续 ASL (pCASL)、FLAIR 和非对比血管造影序列。开发了一个框架来增强显着的低强度静脉体征，然后自动分割 SWI 半影 ROI。计算表观扩散系数 (ADC) 图和脑血流 (CBF) 图。来自 ADC 图的梗塞核心 ROI 和来自 CBF 图的 ASL 半影 ROI 被半自动分割。计算梗塞核心体积、SWI 半影体积 (SPV) 和 pCASL 半影体积并用于计算错配率 11 名患者还在 48 小时内进行了 MRI 随访。MRI 采集包括 DWI、SWI、伪连续 ASL (pCASL)、FLAIR 和非对比血管造影序列。开发了一个框架来增强显着的低强度静脉体征，然后自动分割 SWI 半影 ROI。计算表观扩散系数 (ADC) 图和脑血流 (CBF) 图。来自 ADC 图的梗塞核心 ROI 和来自 CBF 图的 ASL 半影 ROI 被半自动分割。计算梗塞核心体积、SWI 半影体积 (SPV) 和 pCASL 半影体积并用于计算错配率开发了一个框架来增强显着的低强度静脉体征，然后自动分割 SWI 半影 ROI。计算表观扩散系数 (ADC) 图和脑血流 (CBF) 图。来自 ADC 图的梗塞核心 ROI 和来自 CBF 图的 ASL 半影 ROI 被半自动分割。计算梗塞核心体积、SWI 半影体积 (SPV) 和 pCASL 半影体积并用于计算错配率开发了一个框架来增强显着的低强度静脉体征，然后自动分割 SWI 半影 ROI。计算表观扩散系数 (ADC) 图和脑血流 (CBF) 图。来自 ADC 图的梗塞核心 ROI 和来自 CBF 图的 ASL 半影 ROI 被半自动分割。计算梗塞核心体积、SWI 半影体积 (SPV) 和 pCASL 半影体积并用于计算错配率 $骨灰盒：x-wiley：09523480：媒体：nbm4526：nbm4526-math-0001$ 和 $骨灰盒：x-wiley：09523480：媒体：nbm4526：nbm4526-math-0002$ 。SWI 半影 ROI 和 ASL 半影 ROI 之间的 Dice 系数为 0.96 ± 0.07。 $骨灰盒：x-wiley：09523480：媒体：nbm4526：nbm4526-math-0003$ 与良好相关（r = 0.90，p < 0.05） $骨灰盒：x-wiley：09523480：媒体：nbm4526：nbm4526-math-0004$ ，这验证了使用 SWI-DWI 错配比进行准确半影评估的假设。此外，观察到高 SPV 与 MR 血管造影中存在血管闭塞之间存在显着关联。后续数据显示治疗拯救了半影组织（由提议的框架预测的位置和体积）。此外，功能结果分析显示 93.3% 的患者患有 $骨灰盒：x-wiley：09523480：媒体：nbm4526：nbm4526-math-0005$ > 1 人受益于血运重建治疗。总体而言，建议使用 SWI-DWI 失配率对半影进行自动定量评估的性能与 ASL PWI-DWI 失配率相当。这种方法为半影评估所需的灌注序列提供了一种替代方案，它可以在没有灌注序列的情况下将协议的扫描时间减少 17%。

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Penumbra quantification from MR SWI-DWI mismatch and its comparison with MR ASL PWI-DWI mismatch in patients with acute ischemic stroke

In acute-ischemic-stroke patients, penumbra assessment plays a significant role in treatment outcome. MR perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) mismatch ratio can provide penumbra assessment. Recently reported studies have shown the potential of susceptibility-weighted imaging (SWI) in the qualitative assessment of penumbra. We hypothesize that quantitative penumbra assessment using SWI-DWI can provide an alternative to the PWI-DWI approach and this can also reduce the overall scan-time. The purpose of the current study was to develop a framework for accurate quantitative assessment of penumbra using SWI-DWI and its validation with PWI-DWI-based quantification. In the current study, the arterial-spin-labelling (ASL) technique has been used for PWI. This retrospective study included 25 acute-ischemic-stroke patients presenting within 24 hours of the last noted baseline condition of stroke onset. Eleven patients also had follow-up MRI within 48 hours. MRI acquisition comprised DWI, SWI, pseudo-continuous-ASL (pCASL), FLAIR and non-contrast-angiography sequences. A framework was developed for the enhancement of prominent hypo-intense vein signs followed by automatic segmentation of the SWI penumbra ROI. Apparent-diffusion-coefficient (ADC) maps and cerebral-blood-flow (CBF) maps were computed. The infarct core ROI from the ADC map and the ASL penumbra ROI from CBF maps were segmented semiautomatically. The infarct core volume, SWI penumbra volume (SPV) and pCASL penumbra volume were computed and used to calculate mismatch ratios $urn:x-wiley:09523480:media:nbm4526:nbm4526-math-0001$ and $urn:x-wiley:09523480:media:nbm4526:nbm4526-math-0002$ . The Dice coefficient between the SWI penumbra ROI and ASL penumbra ROI was 0.96 ± 0.07. $urn:x-wiley:09523480:media:nbm4526:nbm4526-math-0003$ correlated well (r = 0.90, p < 0.05) with $urn:x-wiley:09523480:media:nbm4526:nbm4526-math-0004$ , which validates the hypothesis of accurate penumbra assessment using the SWI-DWI mismatch ratio. Moreover, a significant association between high SPV and the presence of vessel occlusion in the MR angiogram was observed. Follow-up data showed salvation of penumbra tissue (location and volumes predicted by proposed framework) by treatments. Additionally, functional-outcome analysis revealed 93.3% of patients with $urn:x-wiley:09523480:media:nbm4526:nbm4526-math-0005$ > 1 benefitted from revascularization therapy. Overall, the proposed automated quantitative assessment of penumbra using the SWI-DWI mismatch ratio performs equivalently to the ASL PWI-DWI mismatch ratio. This approach provides an alternative to the perfusion sequence required for penumbra assessment, which can reduce scan time by 17% for the protocol without a perfusion sequence.

更新日期：2021-06-07

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