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Published on: January 23, 2019
The MRA-DWI mismatch identifies patients with stroke who are likely to benefit from reperfusion
Maarten G Lansberg1, Vincent N Thijs, Roland Bammer
1Stanford Stroke Center, 701 Welch Road, Suite B325, Palo Alto, CA 94304-9705, USA. lansberg@stanford.edu
Background And Purpose:
The aim of this exploratory analysis was to evaluate if a combination of MR angiography (MRA) and diffusion-weighted imaging (DWI) selection criteria can be used to identify patients with acute stroke who are likely to benefit from early reperfusion.
Methods:
Data from DEFUSE, a study of 74 patients with stroke who received intravenous tissue plasminogen activator in the 3- to 6-hour time window and underwent MRIs before and approximately 4 hours after treatment were analyzed. The MRA-DWI mismatch model was defined as (1) a DWI lesion volume less than 25 mL in patients with a proximal vessel occlusion; or (2) a DWI lesion volume less than 15 mL in patients with proximal vessel stenosis or an abnormal finding of a distal vessel. Favorable clinical response was defined as an improvement on the National Institutes of Health Stroke Scale score of at least 8 points between baseline and 30 days or a National Institutes of Health Stroke Scale score
Results:
Twenty-seven of 62 patients (44%) had an MRA-DWI mismatch. There was a differential response to early reperfusion based on MRA-DWI mismatch status. Reperfusion was associated with an increased rate of a favorable clinical response in patients with an MRA-DWI mismatch (OR, 12.5; 95% CI, 1.8 to 83.9) and a lower rate in patients without mismatch (OR, 0.2; 95% CI, 0.0 to 0.8).
Conclusions:
The MRA-DWI mismatch model appears to identify patients with stroke who are likely to benefit from reperfusion therapy administered in the 3- to 6-hour time window after symptom onset. The criteria established for the MRA-DWI mismatch model in this study require validation in an independent cohort.
Insights
This study suggests that combining MR angiography (MRA) and diffusion-weighted imaging (DWI) can identify acute stroke patients who benefit from reperfusion therapy within 3-6 hours. The MRA-DWI mismatch model shows promise for guiding treatment decisions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute stroke management requires timely reperfusion therapy.
- Identifying suitable candidates for early treatment is crucial for improving outcomes.
- Advanced neuroimaging plays a key role in stroke diagnosis and treatment selection.
Purpose of the Study:
- To evaluate the efficacy of a combined MR angiography (MRA) and diffusion-weighted imaging (DWI) selection criteria.
- To identify acute stroke patients likely to benefit from early reperfusion therapy (3-6 hours).
- To assess the MRA-DWI mismatch model's predictive value for treatment response.
Main Methods:
- Analysis of data from the DEFUSE study (74 patients with acute stroke).
- Application of the MRA-DWI mismatch model: DWI lesion volume criteria based on vessel occlusion/stenosis.
- Definition of favorable clinical response using NIH Stroke Scale (NIHSS) scores at 30 days.
Main Results:
- 44% of patients (27/62) exhibited an MRA-DWI mismatch.
- Reperfusion therapy significantly increased favorable clinical response in patients with mismatch (OR, 12.5).
- Patients without mismatch showed a lower rate of favorable response to reperfusion (OR, 0.2).
Conclusions:
- The MRA-DWI mismatch model effectively identifies stroke patients who benefit from 3-6 hour reperfusion therapy.
- This imaging model shows potential for guiding clinical decision-making in acute stroke.
- Further validation of the MRA-DWI mismatch criteria in an independent cohort is necessary.
