DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

作者：Liu Dezhi; Scalzo Fabien; Starkman Sidney; Rao Neal M; Hinman Jason D; Kim Doojin; Ali Latisha K; Saver Jeffrey L; Noorian Ali Reza; Ng Kwan; Liang Conrad; Sheth Sunil A; Yoo Bryan; Liu Xinfeng; Liebeskind David S

来源：Cerebrovascular Diseases, 2015, 40(5-6): 279-285.

DOI：10.1159/000441153

• Acute ischemic stroke
• Thrombolysis
• MRI
• Clinical outcome

Background: Lesion patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory; yet it remains unclear whether such imaging prognostic factors are related to patient outcome after intravenous thrombolysis. Aims: The aim of this study is to investigate the clinical outcome after intravenous thrombolysis in acute MCA ischemic strokes with respect to diffusion-weighted imaging (DWI) lesion patterns. Methods: Consecutive acute ischemic stroke cases of the MCA territory treated over a 7-year period were retrospectively analyzed. All acute MCA stroke patients underwent a MRI scan before intravenous thrombolytic therapy was included. DWI lesions were divided into 6 patterns (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts). Lesion volumes were measured by dedicated imaging processing software. Favorable outcome was defined as modified Rankin scale (mRS) of 0-2 at 90 days. Results: Among the 172 patients included in our study, 75 (43.6%) were observed to have territorial infarct patterns or other deep infarct patterns. These patients also had higher baseline NIHSS score (p < 0.001), a higher proportion of large cerebral artery occlusions (p < 0.001) and larger infarct volume (p < 0.001). Favorable outcome (mRS 0-2) was achieved in 89 patients (51.7%). After multivariable analysis, groups with specific lesion patterns, including territorial infarct and other deep infarct pattern, were independently associated with favorable outcome (OR 0.40; 95% CI 0.16-0.99; p = 0.047). Conclusions: Specific lesion patterns predict differential outcome after intravenous thrombolysis therapy in acute MCA stroke patients.

• 出版日期2015
• 单位南京大学