Hatice ŞAP, Muazzez Betigül YÜRÜTEN ÇORBACIOĞLU, Osman Serhat TOKGÖZ

İskemik inmede penumbral alanın sonuç infarkt hacmi ve klinik prognozu üzerine etkisi

Amaç: Klinik seyir üzerine yapılan çalışmalar inme progresyonunu takip etmede çok önemli bir yer tutar. Perfüzyon MR görüntülemelerinin akut iskemik inmede kullanıma girmesi penumbral alanın tespiti ve kurtarılması adına önemli bir köşe taşı olmuştur. Gereç ve Yöntem: İlk 24 saat içinde akut iskemik inme atağı geçiren hastaların geliş difüzyon ve perfüzyon ağırlıklı manyetik rezonans görüntülemeleri (MRG) tespit edildi. Perfüzyon-difüzyon uyumsuzluğu ciddi, orta-hafif ve olmama durumlarına göre 3 gruba ayrıldı. İyi klinik yanıt (İKY)gelişip gelişmediği başlangıç ve 15. gün klinik skorları (The National Institute of Health Stroke Scale, European Stroke Scale and Modified Rankin Scale) kullanılarak tespit edildi. Finalde lezyon hacim (FLH) büyümesi tespiti için 15. gün çekilen T2 ağırlıklı MRG ile başlangıç difüzyon ağırlıklı MRG hacim farkları alındı. Bulgular: Ciddi uyumsuzluğun olduğu grupta FLH de büyüme, hafif-orta uyumsuzluk olan gruba ve uyumsuzluğu olmayan gruba göre anlamlı derecede yüksek idi (sırasıyla, median: 37 cm3, %95 CoI: 26.0-55.0; median: 10 cm3, %95CoI: 0-16.0; median: - 1.50 cm3, %95 CoI: -4.0 /8.0, χ2 = 8.294, p=0.017). Uyumsuzluk ciddiyetinin İKY ile sonlanmaya etkisi ise istatistiksel olarak anlamlı değildi (χ2:1.959, p:0,162). İKY’nin elde edilme oranı FLH de büyüme olmayan grupta büyüme olan gruba göre istatistiksel olarak anlamlı düzeyde yüksek bulundu (χ2:7,62, p:0,02). Ancak ile İKY elde etme adına FLH hacim değişiminin bağımsız bir prediktör özelliği bulunmamıştır (p:0.086, OR:0.972, %95CI:0.942-1.004). Sonuç: Bu çalışmanın sonuçları şiddetli difüzyon-perfüzyon uyumsuzluğu olan akut iskemik inmeli hastaların radyolojik ve klinik gidişatları daha ciddi olabilir ve tedavide daha dikkatli olunmalıdır.

Influence of penumbral area on final infarct volume and clinical outcome in ischemic stroke

Objective: Clinical outcome studies take an important place in following the progression of stroke. The use of perfusion weighted MR imaging in acute ischemic stroke has been an important cornerstone for the detection and treatment of the penumbral area. Material and Method: In the first 24 hours, diffusion and perfusion-weighted magnetic resonance imaging (MRI) were performed in patients with acute ischemic stroke. The perfusion-diffusion mismatch was divided into three groups as the patients with severe, with mild to moderate, and patients without mismatch. Clinical scores changes (The National Institute of Health Stroke Scale, European Stroke Scale and Modified Rankin Scale) at the admission and 15th day were examined to determine whether or not good clinical response (GCR) develops. Final lesion volume (FLV) was calculated as the difference of T2-weighted MRI taken on the 15th day from the initial diffusion-weighted MRI volume. Results: The increase in FLV was significantly higher in the group with severe mismatch than the group with mild to moderate mismatch and group without mismatch. (respectively, median: 37 cm3, %95CoI: 26.0-55.0; median: 10 cm3, %95CoI: 0-16.0; median: - 1.50 cm3, %95CoI: -4.0 /8.0, χ2 = 8.294, p=0.017). The effect of mismatch severity on GCR was not statistically significant (χ2:1.959, p:0,162). The rate of the GCR was found to be lower in the FLV growth group than the non-growth group with statistically significant difference (x² = 7.62, p = 0.02), but FLV change is not a independent predictor for GCR (p:0.086, OR:0.972, %95CI:0.942-1.004). Conclusion: Results of this study has suggested that among patients with acute stroke and severe mismatch, radiological and clinical outcomes can be more serious and treatment should be carefully considered.

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