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Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis

  • Diagnostic Neuroradiology
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Abstract

Introduction:

Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M1–2 segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis.

Methods:

Initial infarct volume (VDWI-I ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum VDWI-I still associated with a good clinical outcome, the patients were divided into two groups (VDWI-I ≤70 ml and >70 ml).

Results:

VDWI-I ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a VDWI-I ≤70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a VDWI-I >70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026).

Conclusion:

Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a VDWI-I ≤70 ml had a significantly better outcome.

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Acknowledgements

We thank Ms. Lucie Kopuletá and Ms. Michaela Kotzmundová, Department of Radiology, Division of MRI, University Hospital, Olomouc, Czech Republic, for their technical help in MRI data processing. This work was supported by the IGA Ministry of Health, Czech Republic (grant number NR/8579-3/2005).

Study protocol was in compliance with the Declaration of Helsinki (1964) and was approved by the Ethical Committee of the University Hospital, Olomouc, Czech Republic.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Stroke Center, Department of Neurology, University Hospital, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic

    Daniel Šaňák, Andrea Bártková, Roman Herzig, David Školoudík, Ivanka Vlachová & Petr Kaňovský

  2. Department of Neurology, University Hospital, Martin, Slovak Republic

    Vladimír Nosál′ & Egon Kurča

  3. Stroke Center, Department of Radiology, University Hospital, Olomouc, Czech Republic

    David Horák, Jiří Bučil, Stanislav Buřval & Martin Köcher

  4. Department of Radiology, University Hospital, Martin, Slovak Republic

    Kamil Zeleňák & Viera Cisariková

  5. Department of Biometry and Statistics, Palacký University Medical School, Olomouc, Czech Republic

    Jana Zapletalová

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  1. Daniel Šaňák
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Correspondence to Daniel Šaňák.

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Šaňák, D., Nosál′, V., Horák, D. et al. Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 48, 632–639 (2006). https://doi.org/10.1007/s00234-006-0105-0

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