Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging

Area of Science:

• Neuroradiology
• Stroke Imaging
• Cerebrovascular Disease

Background:

• Perfusion weighted imaging (PWI) is crucial for mechanical thrombectomy decisions in stroke patients.
• PWI is not always accessible, necessitating alternative imaging assessment methods.
• Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are observable in PWI lesions.

Purpose of the Study:

• To evaluate the NIH-FHV score as a surrogate for PWI in assessing stroke severity.
• To determine if FHV extent can predict the need for mechanical thrombectomy.
• To investigate the utility of FHV in estimating diffusion-perfusion mismatch.

Main Methods:

• Developed and applied the NIH-FHV score to MRI scans of stroke patients.
• Combined NIH-FHV score with diffusion-weighted imaging (DWI) lesion volume to estimate diffusion-perfusion mismatch ratio.
• Utilized linear regression and receiver operating characteristic (ROC) analysis to validate the score's accuracy.

Main Results:

• The NIH-FHV score strongly correlated with PWI lesion volume (R²=0.32, P<0.001).
• The score effectively estimated diffusion-perfusion mismatch ratio (AUC=0.94) when combined with DWI.
• 78% of included patients showed a perfusion deficit on PWI.

Conclusions:

• The NIH-FHV score can estimate PWI lesion volume when perfusion imaging is unavailable.
• This score, combined with DWI, may aid in identifying clinically relevant diffusion-perfusion mismatch.
• Further research is required to validate the clinical application of the NIH-FHV score.