Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Limited research exists on functional outcomes and diffusion-weighted MRI (DWI) lesion extent in posterior circulation (PC) infarction.
• Predicting functional outcomes in PC stroke patients is crucial for effective treatment strategies.

Purpose of the Study:

• To evaluate the utility of a novel posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) derived from DWI in predicting functional outcomes for PC stroke patients.
• To compare clinical and MRI findings between patients with favorable and unfavorable functional outcomes.

Main Methods:

• A cohort of 132 patients with first-ever PC ischemic stroke within 24 hours of onset was analyzed.
• Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS), categorizing patients into favorable (mRS 0-2) and unfavorable (mRS 3-6) groups.
• pc-ASPECTS was calculated from DWI scans obtained 12-36 hours post-onset, and compared with clinical data and other MRI findings like leukoaraiosis and medial temporal atrophy.

Main Results:

• Ninety-eight patients (74.2%) had favorable outcomes, while 34 (25.8%) had unfavorable outcomes.
• Favorable outcome patients were younger, had lower NIHSS scores, less early neurological deterioration (END), and lower rates of cardioembolic stroke.
• On MRI, favorable outcome was associated with lower leukoaraiosis and medial temporal atrophy scores, and a higher pc-ASPECTS score on DWI.

Conclusions:

• The pc-ASPECTS derived from DWI is a powerful independent predictor of functional outcome in PC stroke patients.
• Clinical severity (NIHSS) and early neurological deterioration (END) are also significant independent predictors of functional outcome.
• Leukoaraiosis may serve as an additional independent predictor of functional outcome in this patient population.