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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Final infarct volume discriminates outcome in mild strokes
Achala S Vagal1, Heidi Sucharew2, Shyam Prabhakaran3
1Department of Radiology, University of Cincinnati (UC) College of Medicine and Comprehensive Stroke Center at UC Neuroscience Institute, Cincinnati, OH, USA Achala.Vagal@uchealth.com.
Introduction:
Knowledge of whether final infarct volume (FIV) predicts disability after mild stroke is limited. We sought to determine if FIV could differentiate good versus poor outcome after mild stroke.
Methods:
We retrospectively identified 65 patients with mild stroke (National Institutes of Health Stroke Scale≤5) in a multicenter registry of 2453 patients. We evaluated associations between FIV and clinical outcome and evaluated the optimal FIV threshold that discriminated favorable (modified Rankin scale (mRS) 0-1) versus poor (mRS 2-6) outcome.
Results:
The FIV cut-point of 20 mL differentiated favorable and poor outcomes (area under curve (AUC) 0.73, 95% confidence interval: 0.58-0.88). Favorable outcome was observed in 37/45 (82%) with FIV<20 mL, compared to 5/14 (36%) with FIV≥20 mL (p<0.01). FIV≥20 mL remained strongly associated with poor outcome independent of age, gender, stroke severity, Alberta Stroke Program Early CT Score (ASPECTS), and proximal arterial occlusion.
Conclusion:
In our small sample size, an FIV of 20 mL best differentiated between the likelihood of good versus poor outcome in patients with mild stroke. Further validation of infarct volume as a surrogate marker in mild stroke is warranted.
Insights
Final infarct volume (FIV) of 20 mL can predict disability after mild stroke. A larger FIV (≥20 mL) is linked to poor outcomes, while a smaller FIV (<20 mL) indicates a good prognosis.
Area of Science:
- Neurology
- Stroke Medicine
- Neuroimaging
Background:
- Predicting functional outcomes after mild stroke remains challenging.
- Limited data exists on the utility of final infarct volume (FIV) in predicting disability in mild stroke cases.
Purpose of the Study:
- To determine if FIV can differentiate good versus poor outcomes in patients with mild stroke.
- To identify an optimal FIV threshold for predicting clinical outcomes.
Main Methods:
- Retrospective analysis of 65 mild stroke patients (NIHSS ≤5) from a multicenter registry.
- Evaluation of associations between FIV and modified Rankin Scale (mRS) scores (0-1 for favorable, 2-6 for poor).
- Determining the FIV threshold that best discriminates favorable from poor outcomes.
Main Results:
- An FIV cut-point of 20 mL effectively differentiated favorable and poor outcomes (AUC 0.73).
- Patients with FIV < 20 mL had a favorable outcome (82%), versus 36% with FIV ≥ 20 mL (p<0.01).
- FIV ≥ 20 mL strongly predicted poor outcomes, independent of clinical and imaging factors (age, gender, NIHSS, ASPECTS, arterial occlusion).
Conclusions:
- A final infarct volume of 20 mL serves as a key differentiator for predicting good versus poor outcomes in mild stroke.
- Further research is needed to validate FIV as a surrogate marker for outcomes in mild stroke.
