title: DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.|Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.|UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Dezhi
authors.initials: D
authors.lastname: Liu
authors.affiliation: Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.|UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Scalzo
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Neal M
authors.initials: NM
authors.lastname: Rao
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Hinman
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Noorian
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Kwan
authors.initials: K
authors.lastname: Ng
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Conrad
authors.initials: C
authors.lastname: Liang
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Sunil A
authors.initials: SA
authors.lastname: Sheth
authors.affiliation: UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Yoo
authors.affiliation: Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.|UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000145:classification / Q000188:drug therapy / Q000473:pathology*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator