title: Early magnetic resonance imaging prediction of arterial recanalization and late infarct volume in acute carotid artery stroke.
abstract: In patients with acute ischemic stroke, early recanalization may save tissue at risk for ischemic infarction, thus resulting in smaller infarcts and better clinical outcome. The hypothesis that clinical and diffusion- and perfusion-weighted imaging (DWI, PWI) parameters may have a predictive value for early recanalization and final infarct size was assessed. Twenty-nine patients were prospectively enrolled and underwent sequential magnetic resonance imaging (1) within 6 hours from hemispheric stroke onset, before thrombolytic therapy; (2) at day 1; and (3) at day 60. Late infarct volume was assessed by T2 -weighted imaging. At each time, clinical status was assessed by the National Institutes of Health Stroke Scale (NIHSS). Twenty-eight patients had arterial occlusion at day 0 magnetic resonance angiography (MRA). They were classified into two groups according to day 1 MRA: recanalization (n = 18) versus persistent occlusion (n = 10). Any significant differences between these groups were assessed regarding (1) PWI and DWI abnormality volumes, (2) relative and absolute time-to-peak (TTP) and apparent diffusion coefficient within the lesion on DWI; and (3) day 60 lesion volume on T2 -weighted imaging. Univariate and multivariate logistic regression analysis showed that the most powerful predictive factors for recanalization were lower baseline NIHSS score and lower baseline absolute TTP within the lesion on DWI. The best predictors of late infarct size were day 0 lesion volume on DWI and day 1 recanalization. Early PWI and DWI studies and day 1 MRA provide relevant predictive information on stroke outcome.
authors.affiliation: Department of Radiology and MRI, Hôspital Neurologique, Hospices Civils de Lyon, France. marc.hermier@club-internet.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: Patrice
authors.initials: P
authors.lastname: Adeleine
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthezène
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Hasan
authors.initials: H
authors.lastname: Yilmaz
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dugor
authors.forename: Pascal
authors.initials: P
authors.lastname: Dardel
authors.forename: François
authors.initials: F
authors.lastname: Cotton
authors.forename: Frédéric
authors.initials: F
authors.lastname: Philippeau
authors.forename: Paul
authors.initials: P
authors.lastname: Trouillas
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Froment
mesh_terms: D000208:Acute Disease; D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications*; D002536:Cerebral Arteries / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005544:Forecasting; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome