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Published on: September 25, 2019
Location-weighted versus Volume-weighted Mismatch at MRI for Response to Mechanical Thrombectomy in Acute Stroke
Hikaru Fukutomi1, Takayuki Yamamoto1, Igor Sibon1
1From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.), CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D., T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.) and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University, Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A., L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (M.M.).
Abstract:
Background A target mismatch profile can identify good clinical response to recanalization after acute ischemic stroke, but does not consider region specificities. Purpose To test whether location-weighted infarction core and mismatch, determined from diffusion and perfusion MRI performed in patients with acute stroke, could improve prediction of good clinical response to mechanical thrombectomy compared with a target mismatch profile. Materials and Methods In this secondary analysis, two prospectively collected independent stroke data sets (2012-2015 and 2017-2019) were analyzed. From the brain before stroke (BBS) study data (data set 1), an eloquent map was computed through voxel-wise associations between the infarction core (based on diffusion MRI on days 1-3 following stroke) and National Institutes of Health Stroke Scale (NIHSS) score. The French acute multimodal imaging to select patients for mechanical thrombectomy (FRAME) data (data set 2) consisted of large vessel occlusion-related acute ischemic stroke successfully recanalized. From acute MRI studies (performed on arrival, prior to thrombectomy) in data set 2, target mismatch and eloquent (vs noneloquent) infarction core and mismatch were computed from the intersection of diffusion- and perfusion-detected lesions with the coregistered eloquent map. Associations of these imaging metrics with early neurologic improvement were tested in multivariable regression models, and areas under the receiver operating characteristic curve (AUCs) were compared. Results Data sets 1 and 2 included 321 (median age, 69 years [IQR, 58-80 years]; 207 men) and 173 (median age, 74 years [IQR, 65-82 years]; 90 women) patients, respectively. Eloquent mismatch was positively and independently associated with good clinical response (odds ratio [OR], 1.14; 95% CI: 1.02, 1.27; P = .02) and eloquent infarction core was negatively associated with good response (OR, 0.85; 95% CI: 0.77, 0.95; P = .004), while noneloquent mismatch was not associated with good response (OR, 1.03; 95% CI: 0.98, 1.07; P = .20). Moreover, adding eloquent metrics improved the prediction accuracy (AUC, 0.73; 95% CI: 0.65, 0.81) compared with clinical variables alone (AUC, 0.65; 95% CI: 0.56, 0.73; P = .01) or a target mismatch profile (AUC, 0.67; 95% CI: 0.59, 0.76; P = .03). Conclusion Location-weighted infarction core and mismatch on diffusion and perfusion MRI scans improved the identification of patients with acute stroke who would benefit from mechanical thrombectomy compared with the volume-based target mismatch profile. Clinical trial registration no. NCT03045146 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Nael in this issue.
Insights
Location-weighted imaging metrics for infarction core and mismatch on MRI scans improve prediction of good clinical response to mechanical thrombectomy in acute stroke patients. This approach enhances patient selection compared to standard target mismatch profiles.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Standard target mismatch profiles for acute ischemic stroke do not account for regional brain specificities.
- Identifying patients who will benefit from mechanical thrombectomy is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate if location-weighted infarction core and mismatch, derived from diffusion and perfusion MRI, can better predict good clinical response to mechanical thrombectomy.
- To compare the predictive accuracy of location-weighted metrics against the traditional target mismatch profile.
Main Methods:
- Secondary analysis of two independent stroke datasets (BBS and FRAME).
- Computation of an "eloquent map" based on voxel-wise associations between infarction core and NIH Stroke Scale (NIHSS).
- Determination of target mismatch, and eloquent vs. non-eloquent infarction core and mismatch from acute MRI (diffusion and perfusion).
- Association analysis with early neurologic improvement using multivariable regression and AUC comparison.
Main Results:
- Eloquent mismatch was positively associated with good clinical response (OR, 1.14; P = .02).
- Eloquent infarction core was negatively associated with good response (OR, 0.85; P = .004).
- The inclusion of eloquent metrics improved prediction accuracy (AUC, 0.73) compared to clinical variables alone (AUC, 0.65) or target mismatch profile (AUC, 0.67).
Conclusions:
- Location-weighted infarction core and mismatch metrics derived from diffusion and perfusion MRI enhance the prediction of mechanical thrombectomy benefit in acute stroke.
- This novel imaging approach offers improved patient selection for mechanical thrombectomy compared to volume-based target mismatch profiles.
