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European Radiology

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18-08-2022 | Stroke | Neuro

ASPECTS-based net water uptake predicts poor reperfusion and poor clinical outcomes in patients with ischemic stroke

Authors: Shan-Shan Lu, Rong-Rong Wu, Yue-Zhou Cao, Xiao-Quan Xu, Shu-Shen Lin, Sheng Liu, Hai-Bin Shi, Fei-Yun Wu

Published in: European Radiology | Issue 10/2022

Abstract

Objective

To investigate the value of automated Alberta Stroke Program Early CT Score (ASPECTS)-based net water uptake (NWU) to predict tissue-level reperfusion status and 90-day functional outcomes in acute ischemic stroke (AIS) patients after reperfusion therapy.

Methods

One hundred and twelve patients with AIS who received reperfusion therapy were enrolled. ASPECTS-NWU was calculated from admission CT (NWU_admission) and follow-up CT (NWU_FCT), and the difference (ΔNWU) was calculated. Tissue-level reperfusion status was evaluated via follow-up arterial spin labeling imaging. The relationship between ASPECTS-NWU and tissue-level reperfusion was evaluated. Predictors of 90-day unfavorable outcomes (modified Rankin Scale score > 2) were assessed by multivariate logistic regression analysis and receiver operating characteristic (ROC) curves.

Results

Poor reperfusion was observed in 40 patients (35.7%) after therapy. Those patients had significantly elevated NWU_FCT (median, 14.15% vs. 8.08%, p = 0.018) and higher ΔNWU (median, 4.12% vs. −2.03%, p < 0.001), compared to patients with good reperfusion. High ΔNWU was a significant marker of poor reperfusion despite successful recanalization. National Institutes of Health Stroke Scale score at admission (odds ratio [OR], 1.11; 95% confidence interval [CI] 1.03–1.20, p = 0.007) and ΔNWU (OR, 1.07; 95% CI 1.02–1.13, p = 0.008) were independently associated with unfavorable outcomes. An outcome prediction model including both parameters yields an area under the curve of 0.762 (sensitivity 70.3%, specificity, 84.2%).

Conclusions

Elevated NWU_FCT and higher ΔNWU were associated with poor tissue-level reperfusion after therapy. Higher ΔNWU was an independent predictor of poor reperfusion and unfavorable neurological outcomes despite successful recanalization.

Key Points

• ASPECTS-NWU may provide pathophysiological information about tissue-level reperfusion status and offer prognostic benefits for patients with AIS after reperfusion therapy.

• Elevated NWU_FCT and higher ΔNWU were correlated with poor tissue-level reperfusion after therapy.

• A higher ΔNWU is an independent predictor of poor reperfusion and 90-day unfavorable outcomes despite successful recanalization.

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Title: ASPECTS-based net water uptake predicts poor reperfusion and poor clinical outcomes in patients with ischemic stroke
Authors: Shan-Shan Lu
Rong-Rong Wu
Yue-Zhou Cao
Xiao-Quan Xu
Shu-Shen Lin
Sheng Liu
Hai-Bin Shi
Fei-Yun Wu
Publication date: 18-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Edema
Published in: European Radiology / Issue 10/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-09077-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ASPECTS-based net water uptake predicts poor reperfusion and poor clinical outcomes in patients with ischemic stroke

Abstract

Objective

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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