PDF(Pubmed)
Abstract：
Staging of hemodynamic failure (HF) in symptomatic patients with cerebrovascular steno-occlusive disease is required to assess the risk of ischemic stroke. Since the gold standard positron emission tomography-based perfusion reserve is unsuitable as a routine clinical imaging tool, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) with CO2 is a promising surrogate imaging approach. We investigated the accuracy of standardized BOLD-CVR to classify the extent of HF.
Patients with symptomatic unilateral cerebrovascular steno-occlusive disease, who underwent both an acetazolamide challenge (15O-)H2O-positron emission tomography and BOLD-CVR examination, were included. HF staging of vascular territories was assessed using qualitative inspection of the positron emission tomography perfusion reserve images. The optimum BOLD-CVR cutoff points between HF stages 0-1-2 were determined by comparing the quantitative BOLD-CVR data to the qualitative (15O-)H2O-positron emission tomography classification using the 3-dimensional accuracy index to the randomly assigned training and test data sets with the following determination of a single cutoff for clinical application. In the 2-case scenario, classifying data points as HF 0 or 1-2 and HF 0-1 or 2, BOLD-CVR showed an accuracy of >0.7 for all vascular territories for HF 1 and HF 2 cutoff points. In particular, the middle cerebral artery territory had an accuracy of 0.79 for HF 1 and 0.83 for HF 2, whereas the anterior cerebral artery had an accuracy of 0.78 for HF 1 and 0.82 for HF 2.
Standardized and clinically accessible BOLD-CVR examinations harbor sufficient data to provide specific cerebrovascular reactivity cutoff points for HF staging across individual vascular territories in symptomatic patients with unilateral cerebrovascular steno-occlusive disease.
Patients with symptomatic unilateral cerebrovascular steno-occlusive disease, who underwent both an acetazolamide challenge (15O-)H2O-positron emission tomography and BOLD-CVR examination, were included. HF staging of vascular territories was assessed using qualitative inspection of the positron emission tomography perfusion reserve images. The optimum BOLD-CVR cutoff points between HF stages 0-1-2 were determined by comparing the quantitative BOLD-CVR data to the qualitative (15O-)H2O-positron emission tomography classification using the 3-dimensional accuracy index to the randomly assigned training and test data sets with the following determination of a single cutoff for clinical application. In the 2-case scenario, classifying data points as HF 0 or 1-2 and HF 0-1 or 2, BOLD-CVR showed an accuracy of >0.7 for all vascular territories for HF 1 and HF 2 cutoff points. In particular, the middle cerebral artery territory had an accuracy of 0.79 for HF 1 and 0.83 for HF 2, whereas the anterior cerebral artery had an accuracy of 0.78 for HF 1 and 0.82 for HF 2.
Standardized and clinically accessible BOLD-CVR examinations harbor sufficient data to provide specific cerebrovascular reactivity cutoff points for HF staging across individual vascular territories in symptomatic patients with unilateral cerebrovascular steno-occlusive disease.
摘要：
背景：有症状的脑血管狭窄闭塞性疾病患者的血流动力学衰竭（HF）分期是评估缺血性卒中风险的必要条件。由于基于正电子发射断层扫描的金标准灌注储备不适合作为常规临床成像工具，血氧水平依赖性脑血管反应性(BOLD-CVR)与CO2是一种有前途的替代成像方法.我们调查了标准化BOLD-CVR对HF程度进行分类的准确性。
结果：有症状的单侧脑血管狭窄闭塞性疾病患者，谁接受了乙酰唑胺挑战（15O-）H2O正电子发射断层扫描和BOLD-CVR检查，包括在内。使用正电子发射断层扫描灌注储备图像的定性检查来评估血管区域的HF分期。HF阶段0-1-2之间的最佳BOLD-CVR截止点是通过将定量BOLD-CVR数据与定性（15O-）H2O-正电子发射断层扫描分类进行比较来确定的，该分类使用3维准确性指数对随机分配的训练和测试数据集进行了以下确定，以用于临床应用。在2种情况下，将数据点分为HF0或1-2和HF0-1或2，BOLD-CVR显示HF1和HF2截止点的所有血管区域的准确性>0.7。特别是,大脑中动脉区域对HF1的准确度为0.79，对HF2的准确度为0.83，而大脑前动脉对HF1的准确度为0.78，对HF2的准确度为0.82。
结论：标准化和临床可获得的BOLD-CVR检查包含足够的数据，可以为单侧脑血管狭窄闭塞性疾病有症状患者的单个血管区域的HF分期提供特定的脑血管反应性截止点。
结果：有症状的单侧脑血管狭窄闭塞性疾病患者，谁接受了乙酰唑胺挑战（15O-）H2O正电子发射断层扫描和BOLD-CVR检查，包括在内。使用正电子发射断层扫描灌注储备图像的定性检查来评估血管区域的HF分期。HF阶段0-1-2之间的最佳BOLD-CVR截止点是通过将定量BOLD-CVR数据与定性（15O-）H2O-正电子发射断层扫描分类进行比较来确定的，该分类使用3维准确性指数对随机分配的训练和测试数据集进行了以下确定，以用于临床应用。在2种情况下，将数据点分为HF0或1-2和HF0-1或2，BOLD-CVR显示HF1和HF2截止点的所有血管区域的准确性>0.7。特别是,大脑中动脉区域对HF1的准确度为0.79，对HF2的准确度为0.83，而大脑前动脉对HF1的准确度为0.78，对HF2的准确度为0.82。
结论：标准化和临床可获得的BOLD-CVR检查包含足够的数据，可以为单侧脑血管狭窄闭塞性疾病有症状患者的单个血管区域的HF分期提供特定的脑血管反应性截止点。
