BackgroundThe National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer‐weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment.PurposeTo utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90‐day prognosis in patients diagnosed with ischemic stroke.Study TypeProspective.Subjects61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study.Field Strength/Sequence3T/turbo spin echo (TSE) T1‐weighted imaging, T2‐weighted imaging, T2‐fluid attenuated inversion recovery (T2‐FLAIR), diffusion‐weighted imaging (DWI), and single‐shot TSE APTw imaging.AssessmentAPTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model.Statistical TestsKolmogorov–Smirnov test, t‐test, Mann–Whitney U test, chi‐square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05.ResultsCorrelation analysis revealed that APTw and NIHSS exhibit the highest correlation (r = −0.634, 95% confidence interval [CI] −0.418 to −0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845–0.970), ADC (OR 0.745, 95% CI 0.609–0.911), and infarct core‐cerebral blood volume (IC‐CBV) (OR 0.547, 95% CI 0.310–0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911–0.988), exceeding that of APTw, ADC, and IC‐CBV individually.Data ConclusionThe APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies.Level of Evidence1Technical EfficacyStage 2

中文翻译：

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酰胺质子转移加权 MRI，与缺血性中风临床严重程度和预后的关联

背景美国国立卫生研究院卒中量表 (NIHSS) 和改良 Rankin 量表 (mRS) 评分存在重要缺陷。酰胺质子转移加权（APTw）成像可能为缺血性卒中评估提供更有价值的信息。目的利用APTw、表观扩散系数（ADC）和计算机断层扫描灌注（CTP）评估缺血性卒中的临床症状严重程度和90天预后研究类型前瞻性。受试者 61 名患有缺血性中风的患者（平均年龄 63.2 ± 9.7 岁；46 名男性，15 名女性）纳入研究。场强/序列 3T/涡轮自旋回波 (TSE) T1‐加权成像，T2‐加权成像，T2‐流体衰减反转恢复（T2‐FLAIR）、扩散加权成像（DWI）和单次 TSE APTw 成像。AssessmentAPTw、ADC 和 CTP 用于比较患者亚组并构建预后列线图模型。统计测试 Kolmogorov-Smirnov 检验，t‐检验、Mann-Whitney U 检验、卡方检验、Pearson 相关分析、多元逻辑回归分析、决策曲线分析 (DCA)、受试者工作特征曲线 (ROC)。显着性阈值设置为磷< 0.05。结果相关分析显示，APTw 和 NIHSS 表现出最高的相关性（r= -0.634，95% 置信区间 [CI] -0.418 至 -0.782），超过 ADC 和病变大小。多变量分析显示 APTw（比值比 [OR] 0.905，95% CI 0.845–0.970）、ADC（OR 0.745，95% CI 0.609–0.911）和梗死核心脑血容量（IC-CBV）（OR 0.547，95） % CI 0.310–0.964）作为与不良预后相关的潜在危险因素。列线图模型表现出最高的预测功效，曲线下面积 (AUC) 为 0.960 (95% CI 0.911–0.988)，分别超过 APTw、ADC 和 IC-CBV。 数据结论 APTw 技术在以下领域具有潜在价值：对缺血性脑卒中患者进行分类和管理，为临床治疗策略的实施提供指导。证据级别1技术疗效阶段2