Predictors of Infarct Growth Measured by Apparent Diffusion Coefficient Quantification in Patients with Acute...

The infarct volume is associated with the clinical outcome after ischemic stroke. We investigated the factors associated with infarct growth and its effect on functional outcome in patients with acute ischemic stroke.

The present retrospective study included 158 patients with acute ischemic stroke receiving endovascular treatment at the University of California, Los Angeles, Medical Center from 2011 to 2016. The patients' clinical parameters were collected. Magnetic resonance imaging was performed before treatment and 24 hours after endovascular treatment to calculate the infarct volume. The infarct sizes were measured using apparent diffusion coefficient maps. The modified Rankin scale (mRS) scores at discharge and 90 days after discharge were used to evaluate the functional outcomes. An mRS score of 0-2 was defined as a good outcome. The predictors of infarct growth and mRS score at 90 days were analyzed using regression analysis.

Patients with smaller infarct growth had significantly better clinical outcomes as measured by the mRS score at discharge and at 90 days and mortality at 90 days (P < 0.001). Infarct growth of 12.11 cm² was defined as the optimal cutoff to predict the clinical outcome using the receiver operating characteristic curve. The baseline Alberta Stroke Program Early CT (computed tomography) score (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.665-0.962; P = 0.017) and modified thrombolysis in cerebral infarction score (OR, 0.259; 95% CI, 0.120-0.559; P = 0.001) were independent factors that predicted for infarct growth. Infarct growth (OR, 1.044; 95% CI, 1.024-1.064; P < 0.001) and baseline National Institutes of Health stroke scale score (OR, 1.070; 95% CI, 1.008-1.136; P = 0.027) were independent factors that predicted the mRS score at 90 days.

Infarct growth was associated with the functional outcome. Smaller infarct growth correlated with better outcomes. A greater Alberta Stroke Program Early CT score and better perfusion predicted for smaller infarct growth.