Diffusion-weighted imaging (DWI) ischemic volume is related to FLAIR hyperintensity-DWI mismatch and functional outcome after endovascular therapy

Liang Jiang; Mingyang Peng; Huiyou Chen; Wen Geng; Boxiang Zhao; Xindao Yin; Yu-Chen Chen; Haobo Su

doi:10.21037/qims.2019.12.05

Diffusion-weighted imaging (DWI) ischemic volume is related to FLAIR hyperintensity-DWI mismatch and functional outcome after endovascular therapy

Quant Imaging Med Surg. 2020 Feb;10(2):356-367. doi: 10.21037/qims.2019.12.05.

Authors

Liang Jiang¹, Mingyang Peng¹, Huiyou Chen¹, Wen Geng¹, Boxiang Zhao², Xindao Yin¹, Yu-Chen Chen¹, Haobo Su²

Affiliations

¹ Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
² Department of Intervention, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.

Abstract

Background: We assessed whether diffusion-weighted imaging (DWI) volume was associated with fluid-attenuated inversion recovery vascular hyperintensities (FVH)-DWI mismatch and functional outcome in patients with acute stroke who received endovascular therapy (EVT).

Methods: Fifty-three acute stroke patients who received EVT were enrolled. FVH-DWI mismatch, DWI volume on admission, DWI volume on follow-up, DWI volume growth, the functional outcome at 3 months (mRS) and other clinical data were collected. Receiver operating characteristic (ROC) analysis was performed to evaluate the value of DWI volume in predicting functional outcome after stroke.

Results: The FVH-DWI mismatch group had a smaller DWI volume on admission (13.86±19.58 vs. 65.07±52.21; t=-4.301, P=0.000), a smaller DWI volume on follow-up (29.88±33.52 vs. 112.43±87.19; t=-4.143, P=0.000), and a lower DWI volume growth (16.02±19.90 vs. 47.36±40.06; t=-3.326, P=0.003) than those of the no FVH-DWI mismatch group. The good functional outcome group had a smaller DWI volume on admission (13.30±13.26 vs. 68.56±54.28; t=-5.611, P=0.000), a smaller DWI volume on follow-up (27.65±18.80 vs. 120.25±90.37; t=-5.720, P=0.000), lower DWI volume growth (14.35±15.06 vs. 51.69±41.17; t=-4.737, P=0.001) and a higher FVH-DWI mismatch ratio (75.76% vs. 35%; t=8.647; P=0.004) than those of the poor functional outcome group. ROC analysis showed that the sensitivity and specificity of DWI volume on admission for predicting functional outcome were 65% and 96.97%, respectively (the optimal cut-off value: 33.50 mL); DWI volume on follow-up was 48.6 mL, with a sensitivity and specificity of 80% and 87.88%, respectively; DWI volume growth was 22.25 mL, with a sensitivity and specificity of 70% and 87.88%, respectively.

Conclusions: DWI volume and DWI volume growth can provide the prognostic information of acute stroke patients after thrombectomy.

Keywords: Stroke; diffusion-weighted imaging (DWI); magnetic resonance imaging (MRI); prognosis.