Amide proton transfer imaging can effectively diagnose the ischemic penumbra in acute ischemic stroke patients
Objective To evaluate the diagnostic utility of amide proton transfer(APT)imaging for assessing the ischemic penumbra in patients with acute ischemic stroke and to predict patient prognosis.Methods Fifty-eight patients with acute ischemic stroke who were treated at the Fifth Affiliated Hospital of Zhengzhou University from January to November 2023 were retrospectively analyzed.All patients underwent routine 3T MRI sequences,including arterial spin labeling and APT examinations.The infarct core(IC),ischemic penumbra(IP),and contralateral normal-appearing white matter(CNAWM)were measured using diffusion weighted imaging and arterial spin labeling.APT values and their differences were analyzed.Neurologists assessed the patients using the National Institutes of Health Stroke Scale(NIHSS)on the first day of admission.Patient prognosis was followed up via telephone after three months,assessing modified Rankin Scale(mRS)scores to evaluate neurological recovery.Patients were divided into good prognosis group(n=24,mRS<2)and poor prognosis group(n=34,mRS≥2).Clinical data and APT values for the IC and CNAWM were compared between the two groups.The difference in APT signal intensity between the IC and contralateral CNAWM(ΔAPT)was calculated.Then the analysis of variance was performed,and ROC curve were plotted to determine the AUC based on ΔAPT values.Additionally,correlations between ΔAPT and NIHSS scores were analyzed.Results APT imaging effectively differentiated between the IC,IP and CNAWM regions(P<0.05).The difference in APT values between the IC region and the ΔAPT values of patients in the good and poor prognosis groups was also statistically significant(P<0.001).Additionally,there was a statistically significant difference in NIHSS scores between the two groups(P<0.001).In contrast,no significant differences were found in the remaining clinical data as well as the APT values in the CNAWM region between the two groups(P>0.05).The ΔAPT values served as a better predictor of patient prognosis(AUC=0.732,cut-off value:1.00,95%CI:0.605-0.860).ΔAPT correlated with NIHSS scores on day 1(r=0.569,P<0.001).Conclusion APT imaging can more accurately delineate a patient's ischemic penumbra and predict their prognosis.
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