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Large ischemic lesions on diffusion-weighted imaging done before intravenous tissue plasminogen activator

Kazumi Kimura, Yasuyuki Iguchi, Kensaku Shibazaki

    Stroke
    |June 7, 2008
    PubMed
    Abstract

    Insights

    Diffusion-weighted imaging Alberta Stroke Programme Early CT Score (DWI ASPECTS) predicts outcomes in acute ischemic stroke patients treated with tissue plasminogen activator. A low DWI ASPECTS score indicates a higher risk of poor outcomes.

    Area of Science:

    • Neurology
    • Radiology
    • Emergency Medicine

    Background:

    • Magnetic Resonance Imaging (MRI) detects early ischemic lesions in hyperacute stroke.
    • Predictive value of early ischemic changes on diffusion-weighted imaging (DWI) for patient outcomes remains unclear.

    Purpose of the Study:

    • To assess the relationship between DWI Alberta Stroke Programme Early CT Score (ASPECTS) and patient outcomes.
    • To determine if DWI ASPECTS can predict outcomes in patients receiving tissue plasminogen activator (tPA).

    Main Methods:

    • Prospective study of anterior circulation ischemic stroke patients treated with tPA within 3 hours.
    • MRI including DWI performed before tPA administration.
    • National Institutes of Health Stroke Scale (NIHSS) scores recorded pre- and post-tPA.

    Main Results:

    • 49 patients studied; median baseline DWI ASPECTS was 9.
    • Patients with DWI ASPECTS ≤ 5 showed trends toward less dramatic improvement and more frequent worsening.
    • A DWI ASPECTS ≤ 5 was the sole independent predictor of a bad outcome (OR, 33.4; P=0.0062).

    Conclusions:

    • DWI ASPECTS is a reliable predictor of poor outcomes in acute ischemic stroke.
    • Patients with DWI ASPECTS > 5 are likely eligible for tPA therapy.

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