Lesion homogeneity on diffusion-weighted imaging is a marker of outcome in acute ischemic stroke

Shady Mourad Boss,Hany Mohamed Aref,Mohamed Mahmoud Mostafa,Ramez Reda Moustafa,Magdy Ahmed Moustafa,Ahmed El Sadek

doi:10.1186/s41983-019-0101-z

Shady Mourad Boss, Hany Mohamed Aref + Show 4 more

Open Access

https://doi.org/10.1186/s41983-019-0101-z

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Abstract

Background and purposeMRI Diffusion-weighted imaging (DWI) lesion volume, pattern, and location have all been used to predict outcome of acute ischemic stroke. We hypothesized that homogeneity within the DWI lesion may also be associated with outcome.MethodsBrain MRI including DWI was performed for consecutive acute ischemic stroke patients within 48 h of onset. Patients were classified as having a homogenous or non-homogenous (heterogeneous) DWI lesion visually. NIHSS was recorded at baseline, 1 week and at 1 month. Modified Rankin Scale (mRS) score was assessed at 3 months.ResultsFifteen patients were recruited to each group (homogenous and non-homogenous DWI lesion). There were no significant differences at baseline (p > 0.05). Patients with a homogenous DWI lesion had significantly higher mRS score at 3 months (worse outcome) than those with a non-homogenous (heterogeneous) DWI lesion (median, IQR 4, 2–4 vs. 1, 0–2 respectively, p = 0.001). On repeated measures ANOVA, NIHSS was significantly worse at 1 week and 1 month in patients with a homogenous DWI lesion.ConclusionLesion homogeneity on early MR DWI is a simple and reproducible visual assessment that may be a strong marker of outcome in acute ischemic stroke.

Highlights

Predicting prognosis and outcome in acute ischemic stroke is important, in identifying patients who may benefit from reperfusion therapies and those in which therapy would be futile or harmful
Fifteen patients fulfilling the criteria were recruited with non-homogenous Diffusion-weighted imaging (DWI) lesions and 15 with homogenous DWI lesions
3 patients died in hospital < 1 week after onset and were excluded from further analysis of National Institutes of Health Stroke Scale (NIHSS)

Summary

Introduction

Predicting prognosis and outcome in acute ischemic stroke is important, in identifying patients who may benefit from reperfusion therapies and those in which therapy would be futile or harmful. Structural MRI is a useful tool in predicting outcome and several MR [1, 2], and diffusion-weighted imaging (DWI) characteristics [3,4,5,6], have been identified for this purpose. Lesion volume on DWI images is the most consistent marker of prognosis in most studies, but its use alone to exclude eligible patients has been challenged [7]. MRI Diffusion-weighted imaging (DWI) lesion volume, pattern, and location have all been used to predict outcome of acute ischemic stroke. We hypothesized that homogeneity within the DWI lesion may be associated with outcome

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Discussion

Conclusion