title: Distance to Thrombus in Acute Middle Cerebral Artery Occlusion Predicts Target Mismatch and Ischemic Penumbra.
abstract: OBJECTIVE
  In patients with occlusion of the middle cerebral artery (MCA) treated by intravenous thrombolysis (IVT), the distance to thrombus (DT) has been proposed as a predictor of outcome. The purpose of the present study was to investigate how DT relates to dynamic susceptibility contrast perfusion metrics.
  
  
  METHODS
  Retrospective analysis was undertaken of patients who were diagnosed with acute MCA occlusion by magnetic resonance imaging and treated with IVT. Volumes of time-to-maximum (Tmax) perfusion deficits and diffusion-weighted imaging (DWI) lesions, diffusion-perfusion mismatch volumes, and the presence of target mismatch were determined. Correlations between the above stoke measures and DT were then calculated.
  
  
  RESULTS
  Fifty-five patients were included. DT showed significant inverse correlations with Tmax greater than 4, 6, 8, and 10 seconds, respectively, and mismatch volumes. Using the DT group median (14 mm) as a separator, significant intergroup differences were observed for Tmax greater than 4, 6, and 8 seconds, respectively, and for mismatch volumes. Grouping DT into quartiles showed significant intergroup differences regarding mismatch volumes and Tmax values greater than 4 and 6 seconds. Binary logistic regression identified DT (odds ratio [OR] = .89; 95% confidence interval [CI], .81-.99) and DWI lesion volumes (OR = .92; 95% CI, .86-.97) as independent predictors of target mismatch. A low DT predicted target mismatch with an area under the curve of .69.
  
  
  CONCLUSIONS
  DT correlates inversely with Tmax perfusion deficits and mismatch volumes and acts as an independent predictor of target mismatch.
authors.affiliation: Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany. Electronic address: matthias.gawlitza@medizin.uni-leipzig.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gawlitza
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Friedrich
authors.affiliation: Department of Neurology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hobohm
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schaudinn
authors.affiliation: Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schob
authors.affiliation: Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Quäschling
authors.affiliation: Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Karl-Titus
authors.initials: KT
authors.lastname: Hoffmann
authors.affiliation: Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Donald
authors.initials: D
authors.lastname: Lobsien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy / Q000473:pathology*; D020767:Intracranial Thrombosis / Q000188:drug therapy / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Magnetic resonance angiography; diffusion-weighted imaging; distance to thrombus; perfusion imaging; stroke