■磁共振弥散加权成像(DWI)是缺血性卒中诊断最敏感的方法。然而,DWI可能无法在一定比例的患者中检测到缺血性病变。
■在PRISMA声明之后,系统搜索Medline,Embase,和WebofScience进行到2024年1月3日。纳入仅限于有足够报道的英国文学。合并DWI阴性缺血性卒中的比例。对于二进制变量,使用随机效应模型计算比值比(OR).
■纳入了14项研究,这些研究包括16,268例临床诊断为缺血性卒中的患者和可用的DWI结果。对DWI阴性组的19.6%和DWI阳性组的15.3%进行静脉溶栓(IVT)。在16%的卒中患者中报告了DWI阴性的缺血性卒中(95%CI:10-24%;敏感性分析后:11%[95%CI:8-15%])。在轻度卒中患者中(美国国立卫生研究院卒中量表[NIHSS]为5或以下),24%(95%CI12-42%)的DWI结果为阴性。DWI阴性扫描的预测因素包括后循环卒中,缺血性心脏病史,先前的中风,或先前的短暂性脑缺血发作。心源性栓塞卒中(OR,0.62,95%CI:0.41-0.93)和房颤病史增加了DWI发现阳性的可能性(OR,0.56,95%CI:0.45-0.71)。DWI阴性的缺血性卒中患者具有较高的良好功能结局(改良Rankin量表[mRS]0-1)(OR,2.26;95%CI:1.03-4.92),卒中复发几率较低(OR,0.68;95%CI:0.48-0.96),严重残疾或死亡的几率较低(mRS为3-6)(OR,0.44;95%CI:0.34-0.57)与DWI阳性患者相比。IVT后症状性脑出血的发生率在组间具有可比性。
■DWI阴性结果存在于相当比例的缺血性卒中患者中,可用作预后良好的标志物。
UNASSIGNED: Magnetic resonance diffusion-weighted imaging (DWI) is the most sensitive modality for ischemic stroke diagnosis. However, DWI may fail to detect ischemic lesions in a proportion of patients.
UNASSIGNED: Following PRISMA statement, a systematic search of Medline, Embase, and Web of Science was conducted until January 3, 2024. The inclusion was confined to English literature with sufficient reporting. Proportions of DWI-negative ischemic stroke were pooled. For binary variables, odds ratios (ORs) were computed using the random-effects model.
UNASSIGNED: Fourteen studies constituting 16,268 patients with a clinical diagnosis of ischemic stroke and available DWI findings were included. Intravenous thrombolysis (IVT) was administered to 19.6% of the DWI-negative group and 15.3% of the DWI-positive group. DWI-negative ischemic stroke was reported in 16% (95% CI: 10-24%; after sensitivity analysis: 11% [95% CI: 8-15%]) of stroke patients. Among minor stroke patients (National Institutes of Health Stroke scale [NIHSS] of 5 or less), 24% (95% CI 12-42%) had negative DWI findings. Predictors of DWI-negative scans included posterior circulation stroke, history of ischemic heart disease, prior stroke, or prior transient ischemic attack. Cardioembolic stroke (OR, 0.62, 95% CI: 0.41-0.93) and history of atrial fibrillation increased the likelihood of positive DWI findings (OR, 0.56, 95% CI: 0.45-0.71). Patients with DWI-negative ischemic stroke had higher odds of good functional outcomes (modified Rankin scale [mRS] of 0-1) (OR, 2.26; 95% CI: 1.03-4.92), lower odds of stroke recurrence (OR, 0.68; 95% CI: 0.48-0.96), and lower odds of severe disability or mortality (mRS of 3-6) (OR, 0.44; 95% CI: 0.34-0.57) compared to patients with positive DWI. Rates of symptomatic intracerebral hemorrhage after IVT were comparable between groups.
UNASSIGNED: DWI-negative findings were present in a significant proportion of ischemic stroke patients and may be utilized as a marker for favorable prognosis.