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Updated: Aug 2, 2025
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
FLAIR vascular hyperintensity-DWI mismatch and DWI-FLAIR mismatch ASPECTS for prediction of good outcome after
Utarat Kaewumporn1, Dittapong Songsaeng1, Alisa Kunapinun1
1Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand.
Introduction:
Acute ischemic stroke is a medical emergency caused by decreased blood flow to the brain, leading cause of long-term disability. Recanalization, one of the most concerning difficulties linked with intracranial arterial occlusion, has been used to reduce mortality in ischemic stroke treatment. The mismatch concepts MR PWI-DWI or DWI-FLAIR can help identify patients for thrombolysis.
Purpose:
This paper introduces a novel method of predicting revascularization using the value of fluid-attenuated inversion recovery vascular hyperintensity FVH-DWI mismatch and DWI-FLAIR mismatch, which releases anterior circulation large vessel occlusion (LVO) after endovascular thrombectomy (EVT). Moreover, we present a new scoring system following anatomical region distributed for MCA territory called a DWI-FLAIR MISMATCH ASPECTS.
Result:
Statistical analysis was performed to predict revascularization and functional outcome with 110 patients with anterior circulation LVO treated with EVT. We found that FVH-DWI mismatch was present in 71 patients (89.9 %) with complete revascularization and present in 8 patients (10.1 %) with no/partial revascularization, which had no significant difference (p = 0.12), and there was no significant difference between good functional outcome and poor functional outcome. Moreover, in 76 patients with DWI-FLAIR mismatch ASPECTS of > 6 point-group, present FVH-DWI mismatch in 57 patients (83.8 %) with complete revascularization had a significant difference as compared to 11 patients (16.2 %) with absent FVH-DWI mismatch (p < 0.05). The clinical outcome in complete revascularization is better than no/partial revascularization, and complete revascularization is independently associated with good functional outcomes (p < 0.05).
Conclusion:
FVH-DWI mismatch paired with DWI-FLAIR mismatch ASPECTS > 6 points may be possible to predict revascularization in patients with anterior circulation LVO.
