Lesion volume change after treatment with tissue plasminogen activator can discriminate clinical responders from nonresponders.
OBJECTIVE
A change in acute-to-chronic lesion volume has been proposed as a biomarker for stroke therapies. The objectives of this study were to determine the magnitude of lesion volume change after standard treatment with tissue plasminogen activator and to determine whether specific volume change thresholds can discriminate clinical responders from nonresponders.


METHODS
We measured lesion volume on diffusion weighted at baseline and on 90-day fluid attenuated inversion recovery MRI and scored 3-month modified Rankin Scale in consecutive patients treated with tissue plasminogen activator. We identified variables associated with excellent (modified Rankin Scale 0 to 1) and independent (modified Rankin Scale 0 to 2) outcomes.


RESULTS
We included 53 patients (mean age 69 years, median baseline National Institutes of Health Stroke Scale score 7). The mean acute-to-chronic lesion volume increase was 11.7 (+/-7.7) cm(3). In 23 patients, the chronic lesion was smaller than the baseline lesion. At 3 months, 32 patients had an excellent clinical outcome. Dichotomous volume change variables associated with outcome included decrease in volume >or=30% (P=0.004) and volume increase >or=5 cm(3) (P=0.002).


CONCLUSIONS
In patients given standard tissue plasminogen activator therapy, changes in lesion volume are associated with clinical outcome, and threshold lesion volumes can differentiate excellent and poor outcome, suggesting these as a potential marker of outcome.
Merino
José G
JG
Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Room B1D-733, MSC 1063, Bethesda, MD 20892, USA. merinoj@ninds.nih.gov
Latour
Lawrence L
LL
Todd
Jason W
JW
Luby
Marie
M
Schellinger
Peter D
PD
Kang
Dong-Wha
DW
Warach
Steven
S
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020520:Brain Infarction / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D018450:Disease Progression; D004351:Drug Resistance; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000592:standards; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator