title: Subacute lesion volume as a potential prognostic biomarker for acute ischemic stroke after intravenous thrombolysis.
abstract: BACKGROUND
  The aim of this study was to identify whether subacute diffusion-weighted imaging (DWI) lesion volume could predict long-term outcome in patients who had undergone intravenous thrombolysis.
  
  
  METHODS
  Patients underwent DWI at baseline and 7days after thrombolysis. Outcomes included complete independence (modified Rankin scale [mRS] score 0 to 1), unfavorable outcome (mRS score 4 to 6) at 90days, and mortality within 90days. Multivariate logistic regression analysis was used to identify outcome predictors.
  
  
  RESULTS
  Of 164 patients, 72 patients (43%) achieved complete independence. Poor outcomes were observed in 45 patients (27%) with an unfavorable outcome and 10 patients (6%) who died. Subacute DWI lesion volume was 3.4mL (interquartile range, 1.1-11.6) in patients with complete independence, 90.1mL (23.8-180.2) in patients with unfavorable outcome and 155.5mL (78.4-377.5) in patients who died. In multivariate logistic regression analysis, subacute DWI lesion volume was an independent predictor of complete independence (odds ratio [OR], 0.939; 95% confidence interval [CI], 0.914-0.965; p<0.001), unfavorable outcome (OR, 1.023; 95% CI, 1.014-1.033; p<0.001), and mortality (OR, 1.016; 95% CI, 1.005-1.028; p=0.005).
  
  
  CONCLUSIONS
  Subacute DWI lesion volume is a critical determinant of 90-day functional outcome and mortality after thrombolysis.
authors.affiliation: Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan. Electronic address: ytate.com@gmail.com.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Hamabe
authors.affiliation: Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kanamoto
authors.affiliation: Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Nakaoka
authors.affiliation: Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Morofuji
authors.affiliation: Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Horie
authors.affiliation: Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Izumo
authors.affiliation: Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tsujino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012372:ROC Curve; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005343:Fibrinolytic Agents; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator
keywords: Diffusion-weighted imaging; Ischemic stroke; Outcome; Tissue-type plasminogen activator