title: MRI in patients with acute basilar artery occlusion - DWI lesion scoring is an independent predictor of outcome.
abstract: OBJECTIVE
  We analyzed early diffusion-weighted magnetic resonance imaging of patients with acute basilar artery occlusion by applying different lesion scoring systems and determined their predictive value for favorable outcome.
  
  
  METHODS
  Between 1998 and 2010, patients with confirmed basilar artery occlusion were entered in a local database. magnetic resonance imaging angiography was performed for diagnosis of basilar artery occlusion and/or during initiated recanalization therapy. We analyzed the patients' clinical and radiological baseline data, recanalization, and favorable outcome modified Rankin Scale 0-2 after three-months. Diffusion weighted imaging findings were categorized into lesions in vascular territories as well as by two previously published scores for ischemic damage in the posterior circulation, the Renard score and posterior circulation Acute Stroke Prognosis Early computed tomography Score.
  
  
  RESULTS
  Fifty patients with basilar artery occlusion received an early MRI, and in 30 of those, a follow-up MRI was performed. Median time to baseline MRI was 5·5 h (one-hour to 24 h). Median baseline Renard score and posterior circulation Acute Stroke Prognosis Early CT Score were 2·75 (0-10) and 7 (0-10), respectively. Of the patients, 82% received an acute recanalization therapy and in 78% of those, the basilar artery recanalized. Median time to therapy was five-hours (1·25-20 h). 24% of all patients had a favorable outcome (mRS 0-2). Patients with a favorable outcome had a lower Renard score and higher pcASPECTS, a lower rate of complete basilar artery occlusion, a higher Glasgow coma scale on admission, and a higher rate of successful recanalization (all P < 0·05). After logistic regression, the only independent predictor for favorable outcome was a posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points (odds ratio 3·9, 95% confidence interval 1·4-11·7, P < 0·05).
  
  
  CONCLUSIONS
  In patients with acute basilar artery occlusion, posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points on early diffusion weighted imaging is an independent predictor for favorable outcome.
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany. simon.nagel@med.uni-heidelberg.de
authors.forename: Simon
authors.initials: S
authors.lastname: Nagel
authors.forename: Christian
authors.initials: C
authors.lastname: Herweh
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.forename: Sven
authors.initials: S
authors.lastname: Poli
authors.forename: Marius
authors.initials: M
authors.lastname: Hartmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Hähnel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000473:pathology* / Q000628:therapy; D001488:Basilar Artery / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015424:Reperfusion; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult