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Published on: September 25, 2019
DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis
Dezhi Liu1,2,3, Fabien Scalzo2,3, Sidney Starkman3
1Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Background:
Lesion patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory; yet it remains unclear whether such imaging prognostic factors are related to patient outcome after intravenous thrombolysis.
Aims:
The aim of this study is to investigate the clinical outcome after intravenous thrombolysis in acute MCA ischemic strokes with respect to diffusion-weighted imaging (DWI) lesion patterns.
Methods:
Consecutive acute ischemic stroke cases of the MCA territory treated over a 7-year period were retrospectively analyzed. All acute MCA stroke patients underwent a MRI scan before intravenous thrombolytic therapy was included. DWI lesions were divided into 6 patterns (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts). Lesion volumes were measured by dedicated imaging processing software. Favorable outcome was defined as modified Rankin scale (mRS) of 0-2 at 90 days.
Results:
Among the 172 patients included in our study, 75 (43.6%) were observed to have territorial infarct patterns or other deep infarct patterns. These patients also had higher baseline NIHSS score (p < 0.001), a higher proportion of large cerebral artery occlusions (p < 0.001) and larger infarct volume (p < 0.001). Favorable outcome (mRS 0-2) was achieved in 89 patients (51.7%). After multivariable analysis, groups with specific lesion patterns, including territorial infarct and other deep infarct pattern, were independently associated with favorable outcome (OR 0.40; 95% CI 0.16-0.99; p = 0.047).
Conclusions:
Specific lesion patterns predict differential outcome after intravenous thrombolysis therapy in acute MCA stroke patients.
Insights
Specific diffusion-weighted imaging lesion patterns in acute middle cerebral artery (MCA) stroke predict patient outcomes after thrombolysis. These imaging markers can help identify patients likely to achieve favorable results post-treatment.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Prognosis in acute ischemic stroke within the middle cerebral artery (MCA) territory can be influenced by lesion patterns.
- The relationship between these imaging prognostic factors and patient outcomes following intravenous thrombolysis remains unclear.
Purpose of the Study:
- To investigate the clinical outcomes of acute MCA ischemic strokes treated with intravenous thrombolysis.
- To correlate diffusion-weighted imaging (DWI) lesion patterns with patient outcomes.
Main Methods:
- Retrospective analysis of 172 acute MCA stroke patients treated over 7 years.
- MRI scans, including DWI, were performed before thrombolytic therapy.
- DWI lesions were categorized into 6 patterns, and volumes were measured; favorable outcome was defined as modified Rankin scale (mRS) 0-2 at 90 days.
Main Results:
- Territorial infarct or other deep infarct patterns were observed in 43.6% of patients, associated with higher NIHSS scores, more large artery occlusions, and larger infarct volumes.
- A favorable outcome (mRS 0-2) was achieved by 51.7% of patients.
- Multivariable analysis revealed that territorial and other deep infarct patterns were independently associated with favorable outcomes (OR 0.40; 95% CI 0.16-0.99; p = 0.047).
Conclusions:
- Specific diffusion-weighted imaging (DWI) lesion patterns are significant predictors of differential outcomes in acute middle cerebral artery (MCA) stroke patients receiving intravenous thrombolysis.
- These findings highlight the prognostic value of DWI lesion patterns in guiding treatment decisions and predicting recovery.
