Abstract
Objective: Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) is a simple, widely used method to estimate the size of the infarct. Our aim is to determine whether there is a relationship between DWI-ASPECTS and fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)-DWI mismatch and to better quantify FVH-DWI mismatch to assess the prognosis of cerebral infarction.Materials and Methods: A retrospective analysis of 109 patients with MCA stenosis or occlusion with cerebral infarction was performed by dividing this cohort into FVH-DWI match group and FVH-DWI mismatch group based on FVH and DWI results. The clinical and imaging data of these two groups of patients were reviewed and analyzed to identify associations between FVH-DWI mismatch and prognosis of patients for preservation of neurological function. Correlation between DWI-ASPECTS and FVH-DWI mismatch was also performed.Results: FVH-DWI mismatch was present in 66/109 (60.55%) patients, and FVH-DWI match was present in 43/109 (39.45%). Patients with FVH-DWI mismatch had higher DWI-ASPECTS (7.0 vs. 4.0, P < 0.001) and lower mRS at 3 months (3.0 vs. 4.0, P < 0.001) than patients without FVH-DWI mismatch. Multiple regression analysis suggested that DWI-ASPECTS (OR = 4.7, 95% CI = 2.5–9.2, P < 0.001) remained significantly associated with FVH-DWI mismatch. Two threshold points for DWI-ASPECTS of 3 and 8 can be used to distinguish whether there is a mismatch in FVH-DWI by smooth curve fitting.Conclusions: The DWI-ASPECTS score was an independent predictor of FVH-DWI mismatch. At DWI-ASPECTS ≤ 3, the FVH-DWI mismatch offers no prognostic value; whereas, at DWI-ASPECTS ≥ 8, the FVH-DWI mismatch had the highest prognostic value. DWI-ASPECTS can roughly determine whether there is a FVH-DWI mismatch in order to select optimal clinical treatment and accurately assess prognosis.
Highlights
Accurate assessment of the prognosis of ischemic stroke can help in selection of optimal treatment and may improve patient survival rate and reduce the rate of disability (1–3)
The latest DEFUSE 3 trial showed that large vessel occlusion thrombectomy in patients within [6,7,8,9,10,11,12,13,14,15,16] h after the onset of stroke resulted in lower disability and higher functional independence at 3 months, and this study have revealed that collateral circulation plays an important role in predicting outcomes (1)
There was no significant difference between the two groups in gender, systolic blood pressure and diastolic blood pressure, serum glucose, Cholesterol, HDL, LDL, smoking, drinking, CAD, homocysteine, stroke/TIA, stenosis rates, Fluid-attenuated inversion recovery vascular hyperintensity (FVH) scores, initial National Institutes of Health Stroke Scale Score (NIHSS) scores, and discharge NIHSS scores (P > 0.05)
Summary
Accurate assessment of the prognosis of ischemic stroke can help in selection of optimal treatment and may improve patient survival rate and reduce the rate of disability (1–3). The current investigations of the relationship between FVH and DWI have suggest that FVHDWI mismatch rather than FVH-DWI match can better predict prognosis (5–8). Several previous studies suggested that FVHDWI mismatch can help assess the clinical neurological outcome, ischemic penumbra and thrombolytic therapy in patients with acute cerebral infarction (5, 7, 8). FVH-DWI mismatch has high sensitivity to PWI-DWI mismatch and can be used to rapidly identify acute ischemic stroke patients with proximal vascular occlusion and reperfusion therapy (7). There are no unified FVH quantitative assessment methods to discriminate the relationship between FVH and DWI (7–9)
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