Early Change in Stroke Size Performs Best in Predicting Response to Therapy

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute stroke management requires reliable biomarkers to assess treatment response.
• Current biomarkers like final infarct volume and early reperfusion have limitations.
• Early fluctuations in stroke volume's potential as a biomarker are underexplored.

Purpose of the Study:

• To evaluate the clinical relevance of early changes in stroke volume.
• To compare early stroke volume changes with final infarct volume and early reperfusion.
• To determine the most effective imaging biomarker for predicting early neurologic improvement (ENI) in acute stroke.

Main Methods:

• Analysis of serial MRI scans (baseline, 2h, 24h) from 58 acute stroke patients receiving thrombolysis.
• Calculation of early stroke volume change, 24h infarct volume, and percent early reperfusion.
• Logistic regression and ROC analysis to compare biomarker efficacy for predicting ENI (≥4 NIHSS decrease within 24h).

Main Results:

• Early change in stroke volume significantly predicted ENI (OR 0.93, p=0.048), with a 10% decrease in ENI odds for every 1mL stroke volume increase.
• This association remained significant after controlling for stroke size and severity (OR 0.90, p=0.032).
• Neither 24h infarct volume nor percent early reperfusion showed significant association with ENI; ROC analysis confirmed early stroke volume change as the only significant biomarker (p=0.03).

Conclusions:

• Early changes in stroke volume are a more reliable imaging biomarker for predicting acute stroke treatment response.
• This finding suggests early stroke size fluctuation is superior to traditional measures.
• Utilizing early stroke volume changes can enhance therapeutic monitoring in acute stroke care.