title: ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic stroke patients.
abstract: The purpose of this study was to develop and evaluate a scoring system for assessing reperfusion status based on arterial spin labeled (ASL) perfusion MRI in acute ischemic stroke (AIS) patients receiving thrombolysis and/or endovascular treatment. Pseudo-continuous ASL with background suppressed 3D GRASE was acquired along with DWI in 90 patients within 24 h post-treatment. An automatic reperfusion scoring system (auto-RPS) was devised based on the Alberta Stroke Program Early CT Score (ASPECTS) template, and compared with manual RPS and DWI-ASPECTS. TICI (thrombolysis in cerebral infarction) scores were graded in 48 patients who received endovascular treatment. Favorable outcomes were defined by a modified Rankin Scale score of 0-2 at three months. Auto-RPS was positively correlated with DWI-ASPECTS (ρ = 0.6, P < 0.001) and was on average 1 point lower than DWI-ASPECTS ( P < 0.001). The area under the receiver operating characteristic curve for discriminating poor functional outcome (n = 90) was 0.75 (95% CI, 0.64-0.86) for manual RPS, 0.85 (95% CI, 0.76-0.94) for auto-RPS, and 0.81 (95% CI, 0.71-0.90) for DWI-ASPECTS. Multiple logistic regression analysis in the TICI-graded patients (n = 48) showed that auto-RPS is highly associated with functional outcome (OR = 25.2, 95% CI 4.02-496, P < 0.01). Post treatment auto-RPS within 24 h provides a useful tool to predict functional outcome in AIS patients.
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.|2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Songlin
authors.initials: S
authors.lastname: Yu
authors.affiliation: 3 Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, CA, USA.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Ma
authors.affiliation: 4 Neurovascular Imaging Research Core and Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: 5 Neuro-Intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Yu
authors.affiliation: 6 Department of Biomathematics, UCLA, Los Angeles, CA, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: 7 Department of Radiology, UCLA, Los Angeles, CA, USA.
authors.forename: Xin J
authors.initials: XJ
authors.lastname: Qiao
authors.affiliation: 3 Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, CA, USA.
authors.forename: Xingfeng
authors.initials: X
authors.lastname: Shao
authors.affiliation: 3 Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, CA, USA.
authors.forename: Lirong
authors.initials: L
authors.lastname: Yan
authors.affiliation: 7 Department of Radiology, UCLA, Los Angeles, CA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Yoo
authors.affiliation: 4 Neurovascular Imaging Research Core and Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Scalzo
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Hinman
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Sharma
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: Rao
authors.affiliation: 8 Division of Interventional Neuroradiology and Stroke Center, UCLA, Los Angeles, CA, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.affiliation: 8 Division of Interventional Neuroradiology and Stroke Center, UCLA, Los Angeles, CA, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: 7 Department of Radiology, UCLA, Los Angeles, CA, USA.
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.affiliation: 1 Department of Neurology, UCLA, Los Angeles, CA, USA.|3 Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, CA, USA.
authors.forename: Danny Jj
authors.initials: DJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D015424:Reperfusion; D015427:Reperfusion Injury / Q000000981:diagnostic imaging*; D013113:Spin Labels; D020521:Stroke / Q000000981:diagnostic imaging*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D013113:Spin Labels
keywords: Acute ischemic stroke; arterial spin labelling; recanalization; reperfusion; reperfusion injury