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Published on: September 25, 2016
Factors associated with decreasing diffusion-weighted imaging-positive area volume after mechanical thrombectomy in
Ryosuke Shintoku1, Tatsuya Shimizu1, Masanori Aihara1
1Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
Abstract:
ObjectivesThis study aimed to evaluate the factors associated with decreasing diffusion-weighted imaging (DWI) positive areas in patients with large early ischemic changes after mechanical thrombectomy (MT).Materials and MethodsThis retrospective single-center clinical study was conducted between January 2013 and December 2022. We included consecutive patients who underwent MT for acute large-vessel occlusion of the anterior circulation with low pretreatment DWI-Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) (0-5), effective recanalization [thrombolysis in cerebral infarction (TICI) 2b or TICI3], and magnetic resonance imaging (MRI) acquired before and after MT. We measured the DWI-positive area volume before and after MT. The primary endpoint was the after/before-MT DWI-positive area-volume ratio.ResultsIn total, 28 patients were included in this study. Eight patients (29%) had an after/before-MT DWI-positive area-volume ratio of <1. The median mean apparent diffusion coefficient (ADC) levels of the DWI-positive areas in the groups with a ratio of <1 or >1 were 717 × 10⁶ mm2/s and 637 × 106 mm2/s, respectively (p = 0.011). Multivariate logistic regression analysis showed that ADC level (OR, 1.020 [95% confidence intervals (CIs), 1.001-1.040]; p = 0.040) was an independent predictor of a decreased DWI-positive area after MT. There was a negative correlation between the mean ADC level and the after/before-MT DWI-positive area-volume ratio (p < 0.001, |ρ| = 0.650), and the mean pretreatment ADC cutoff level was 649 × 106 mm2/s (area under the curve (AUC) = 0.806) for predicting a volume ratio of <1.ConclusionsThe mean ADC level before-MT correlated with the after/before-MT DWI-positive area-volume ratio. A mean pretreatment ADC cutoff level of 649 × 106 mm2/s predicted a decreased DWI-positive area after MT.
Insights
Higher mean apparent diffusion coefficient (ADC) levels before mechanical thrombectomy (MT) predict reduced diffusion-weighted imaging (DWI) positive areas after stroke treatment. A pretreatment ADC cutoff of 649 × 10⁶ mm²/s indicates a decreased DWI positive area post-MT.
Area of Science:
- Neuroradiology
- Neuroimaging
- Stroke Imaging
Background:
- Mechanical thrombectomy (MT) is a key treatment for acute large-vessel occlusion stroke.
- Early and extensive ischemic changes on diffusion-weighted imaging (DWI) can impact treatment outcomes.
- Predicting the reduction of infarct core volume after MT is crucial for patient management.
Purpose of the Study:
- To identify factors associated with the reduction of DWI-positive areas after MT in patients with large early ischemic changes.
- To evaluate the predictive value of pretreatment apparent diffusion coefficient (ADC) on infarct core volume changes post-MT.
Main Methods:
- Retrospective analysis of 28 patients undergoing MT for anterior circulation large-vessel occlusion with low pretreatment ASPECTS (0-5).
- Measurement of DWI-positive lesion volumes before and after MT using MRI.
- Correlation analysis between pretreatment ADC values and the post/pre-MT DWI volume ratio.
Main Results:
- A decreased DWI-positive area (volume ratio <1) was observed in 29% of patients.
- Higher median mean ADC levels were found in patients with a reduced DWI-positive area post-MT (717 vs. 637 × 10⁶ mm²/s; p=0.011).
- Mean pretreatment ADC level was an independent predictor of decreased DWI-positive area (OR 1.020; p=0.040) and showed a strong negative correlation with the volume ratio (ρ=-0.650; p<0.001).
Conclusions:
- The mean apparent diffusion coefficient (ADC) level before mechanical thrombectomy (MT) is significantly correlated with the reduction in diffusion-weighted imaging (DWI) positive areas.
- A pretreatment mean ADC cutoff level of 649 × 10⁶ mm²/s can predict a decreased DWI-positive area after MT, aiding in outcome prediction.
