Abstract
Perfusion imaging is useful to assess tissue recovery in patients with acute ischemic stroke (AIS); however, it cannot reflect tissue metabolism. We postulated that amide proton transfer (APT) imaging can characterize the tissue status after reperfusion therapy, thus providing prognostic value for 90-day functional outcomes. We included 63 patients with AIS and large-vessel occlusion (LVO). The APT signals, including APT# and NOE# (nuclear Overhauser enhancement) were quantified. Ischemic lesions observed on APT# and diffusion-weighted imaging (DWI) were classified according to their mismatch patterns (APT# < DWI; APT# ≥ DWI). Predictors of 90-day good outcomes (modified Rankin scale score 0-2) were evaluated. Patients with successful reperfusion exhibited higher APT#, smaller percentage change of APT#, and a greater likelihood of presenting APT# < DWI compared to those with poor reperfusion (all P < 0.05). The APT# (odds ratio [OR] = 11.48, P = 0.046) and a mismatch pattern of APT# < DWI (OR = 7.41, P = 0.020) independently predicted good outcomes besides the clinical parameters. A mismatch pattern of APT# ≥ DWI was a significant marker of poor outcomes despite successful reperfusion (P = 0.002). Our study provides preliminary evidence that APT may reveal tissue recovery after reperfusion and predict good outcomes at 90 days in patients with AIS and LVO.
Published Version
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