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European Radiology
Published in: European Radiology 12/2020

01-12-2020 | Magnetic Resonance Imaging | Neuro

Perfusion recovery on TTP maps after endovascular stroke treatment might predict favorable neurological outcomes

Authors: Jaewon Shin, Ye Sel Kim, Hyun-Soon Jang, Keon Ha Kim, Pyoung Jeon, Jong-Won Chung, Woo-Keun Seo, Oh Young Bang, Gyeong-Moon Kim

Published in: European Radiology | Issue 12/2020

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Abstract

Objectives

Early recanalization and adequate collateral blood flow are surrogates for functional recovery in endovascular stroke treatment (EVT). We evaluated the prognostic value of pre- and immediate post-thrombectomy perfusion-weighted magnetic resonance imaging (PWI) parameters.

Methods

Consecutive patients with acute ischemic stroke who underwent EVT were enrolled. Lesion volumes and their corresponding changes on diffusion-weighted (DWI) and PWI were assessed. Outcome was measured with modified Rankin Scale (mRS) at 90 days, and early neurological improvement (> 8 points improvement on National Institutes of Health Stroke Scale [NIHSS] or 0 to 1) at 7 days.

Results

Fifty-two patients were enrolled. After control of initial NIHSS and recanalization status, post-thrombectomy time-to-peak (TTP) hypoperfused volume and TTP hypoperfused volume change remained independent predictors of favorable functional outcome (odds ratio [OR] = 0.13, 95% confidence interval [CI] = 0.03–0.54, p = 0.005; OR = 1.018, 95% CI = 1.00–1.03, p = 0.017), and early neurological improvement (OR = 0.20, 95% CI 0.07–0.58, p = 0.003; OR = 1.02, 95% CI = 1.00–1.03, p = 0.010). The areas under the curve of post-thrombectomy TTP hypoperfused volume and TTP hypoperfused volume change were 0.90 and 0.82 (cutoff 68 mL and 56 mL) for favorable outcome and 0.86 and 0.82 (cutoff 76 mL and 58 mL) for early neurological improvement, which had better prognostic values than other MR parameters and recanalization grades.

Conclusions

These results suggest a large amount of perfusion recovery on TTP is associated with favorable outcome as well as early neurological improvement after EVT, and may be a useful prognostic marker.

Key Points

• A large amount of perfusion recovery on TTP map is associated with favorable outcome and early neurological improvement after EVT.
• The best cutoff value for favorable functional outcome was 68 mL for post-EVT TTP hypoperfused volume and 56 mL decrease for TTP hypoperfused volume.
• Amount of perfusion recovery on TTP map has better performance on the prediction of favorable functional recovery and early neurological improvement than other diffusion- and perfusion-weighted MRI parameters and recanalization grades.
Appendix
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Metadata
Title
Perfusion recovery on TTP maps after endovascular stroke treatment might predict favorable neurological outcomes
Authors
Jaewon Shin
Ye Sel Kim
Hyun-Soon Jang
Keon Ha Kim
Pyoung Jeon
Jong-Won Chung
Woo-Keun Seo
Oh Young Bang
Gyeong-Moon Kim
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07066-3

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