Cerebral infarct volume measurements to improve patient selection for endovascular treatment

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Large cerebral infarctions can impact treatment decisions for endovascular therapy.
• Accurate infarct volume measurement is crucial for predicting outcomes in acute ischemic stroke.
• Identifying futile outcomes is essential for optimizing patient selection for endovascular treatment.

Purpose of the Study:

• To evaluate the effectiveness of various infarct volume measurement methods in predicting futile outcomes after endovascular treatment for acute ischemic stroke.
• To compare the predictive power of different imaging techniques, including noncontrast computed tomography (NCCT), postcontrast CT (PCCT), and diffusion-weighted imaging (DWI), for futile outcomes.
• To determine the reliability and predictive accuracy of DWI ASPECTS and infarct core volume in identifying patients with poor prognoses.

Main Methods:

• Patients with acute ischemic stroke in the anterior circulation treated with intra-arterial thrombectomy were included.
• Infarct volume was assessed using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on NCCT, PCCT, and DWI, as well as semiquantitative DWI stroke volume and quantitative infarct core volume.
• Inter-reader reliability was assessed using intraclass correlation coefficients (ICC), and predictive performance for futile outcomes was evaluated using receiver operating characteristic (ROC) curve analyses and multivariable comparative analyses.

Main Results:

• Inter-reader agreement was excellent for DWI stroke volume (ICC, 0.973), DWI ASPECTS (0.940), and PCCT ASPECTS (0.859), but moderate for NCCT ASPECTS (0.694).
• DWI ASPECTS (area under ROC 0.733), DWI stroke volume (0.702), and infarct core volume (0.702) showed significantly higher predictive power for futile outcomes compared to NCCT ASPECTS (0.551).
• Multivariable analyses identified DWI ASPECTS and infarct core volume, along with older age and higher NIHSS scores, as independent predictors of futile outcomes.

Conclusions:

• Diffusion-weighted imaging ASPECTS (DWI ASPECTS) is a valuable and easily measurable parameter for predicting futile outcomes in patients with acute ischemic stroke undergoing endovascular treatment.
• MRI-based parameters, specifically DWI ASPECTS and infarct core volume, demonstrate superior predictive accuracy for futile outcomes compared to CT-based ASPECTS.
• These findings highlight the importance of advanced imaging techniques in optimizing patient selection and managing expectations for endovascular stroke therapy.