Diaschisis revisited: quantitative evaluation of thalamic hypoperfusion in anterior circulation stroke

Reidler, Paul; Müller, Franziska; Stueckelschweiger, Lena; Feil, Katharina; Kellert, Lars; Fabritius, Matthias P.; Liebig, Thomas; Tiedt, Steffen; Puhr-Westerheide, Daniel und Kunz, Wolfgang G. (2020): Diaschisis revisited: quantitative evaluation of thalamic hypoperfusion in anterior circulation stroke. In: Neuroimage-Clinical, Bd. 27, 102329

Abstract

Purpose: Ipsilateral thalamic diaschisis (ITD) refers to the phenomenon of thalamic hypoperfusion or hypometabolism due to a distant cerebral injury. To further investigate the characteristics and spectrum of ITD, we analyzed quantitative measurements of thalamic hypoperfusion in acute anterior circulation stroke. Methods: We selected consecutive patients with large-vessel occlusion (LVO) anterior circulation stroke and available CT perfusion (CTP) examination on admission who underwent endovascular thrombectomy. Thalamic perfusion parameters on CTP were tested between ipsi- and contralesional thalamus and ischemic territory. Values were compared with thresholds from CTP analysis software. Associations of thalamic perfusion parameters with acute imaging and clinical data were determined in uni- and multivariate logistic regression analyses. Results: Ninety-nine patients were included. All perfusion parameters indicated significant non-ischemic hypoperfusion of the thalamus, not reaching the levels of ischemia in the middle cerebral artery territory due to LVO (all p < 0.002). Multiple perfusion parameters exhibited significant association with ischemic lesion extent (relative cerebral blood flow [CBF]: beta = - 0.23, p = 0.022;Delta time to drain: beta = 0.33, p < 0.001;Delta Tmax: beta = - 0.36, p < 0.001) and involvement of the Lentiform Nucleus (Delta mean transit time: beta = 0.64, p = 0.04;Delta time to drain: beta = 0.81, p = 0.01;Delta Tmax: beta = - 0.82, p = 0.01). Symptom severity on admission exhibited minor significant association with reduction of thalamic CBF in uncorrected analysis (Odds ratio: 0.05, p = 0.049), but short- and long-term outcomes were unaffected by perfusion status. ITD reached guideline-based software-threshold levels in only one patient. Conclusions: ITD in acute stroke is a non-binary phenomenon affected by lesion extent and involvement of the lentiform nucleus. We found uncorrected association of ITD with early clinical presentation, but no association with short- or long-term outcome was evident. Relevant misclassification of ITD by guideline-based CTP software was not indicated, which needs further dedicated testing.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2213-1582
• Sprache: Englisch