Abstract
Background and Purpose: MRI is useful for detecting early ischemic lesions prior to administration of tissue plasminogen activator (t-PA) in hyperacute ischemic stroke patients. However it is unclear whether early ischemic change seen on DWI can be used to predict patient outcomes.
Methods: Consecutive anterior-circulation ischemic stroke patients treated with t-PA within 3 h of stroke onset were prospectively studied. The NIHSS score was obtained before and 7 days after t-PA administration. MRI including DWI was done prior to t-PA thrombolysis. The relationship between the DWI ASPECTS and patients' outcomes was assessed.
Results: The subjects consisted of 49 consecutive stroke patients (27 males; mean age, 72.9±10.3 years). The median (range) of the baseline DWI ASPECTS value was 9 (3-10). Dramatic improvement was seen in 1 of 8 patients with an ASPECTS ≤5 compared to 21 of 41 patients with an DWI ASPECTS >5 (P=0.0592). On the other hand, worsening was noted more frequently in patients with a DWI ASPECTS ≤5 (3 of 8 patients) than in patients with an ASPECTS >5 (4 of 41 patients; P=0.0753). Bad outcome was seen more frequently in patients with an DWI ASPECTS ≤5 (6 of 8 patients) than in patients with an DWI ASPECTS >5 (2 of 41 patients; P<0.0001). Multivariate logistic regression analysis demonstrated that an DWI ASPECTS ≤5 was the only independent predictor of a bad outcome (OR 33.4 95%CI 2.7-410.8, P=0.0062).
Conclusion: DWI ASPECTS appears to be a reliable tool for predicting bad outcome. Patients with an DWI ASPECTS >5 should be considered eligible for t-PA therapy.
