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Relative CBV ratio on perfusion-weighted MRI indicates the probability of early recanalization after IV t-PA administration for acute ischemic stroke
  1. Sang-Wook Sohn,
  2. Hyun-Seok Park,
  3. Jae-Kwan Cha,
  4. Dae-Hyun Kim,
  5. Myung-Jin Kang,
  6. Jae-Hyung Choi,
  7. Hyun-Wook Nah,
  8. Jae-Taeck Huh
  1. Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Korea
  1. Correspondence to Professor Jae-Kwan Cha, Busan-Ulsan Regional Cardio-Cerebrovascular Diseases Center, Dong-A University Hospital, Department of Neurology, 3-1Ga, Dongdaeshin-Dong, Busan 602-715, Republic of Korea; nrcjk65{at}gmail.com

Abstract

Background We hypothesized that the relative cerebral blood volume (rCBV) ratio on perfusion-weighted imaging (PWI) using MRI might serve as a predictor of early recanalization (ER) after intravenous tissue plasminogen activator (IV t-PA) administration for acute ischemic stroke.

Methods Patients with acute middle cerebral artery (MCA) ischemic stroke (IS) were enrolled in the study. They were evaluated by MRI, including PWI and diffusion-weighted imaging, before administration of IV t-PA and underwent digital subtraction angiography (DSA) of the brain within 2 h after t-PA administration. We compared the rCBV ratio on PWI between patients with and without ER on DSA and investigated the proportion of patients with an excellent outcome at 90 days after t-PA administration (modified Rankin Scale score 0–1) among those with and without ER.

Results 85 patients with acute MCA IS were included; 16 patients (18.8%) experienced ER on DSA after IV t-PA administration. Patients with ER more frequently had an excellent outcome at 90 days than those without ER. The rCBV ratio on PWI was higher in the ER group (1.01±0.21, p<0.01) than in the non-ER group (0.82±0.18). After adjusting for the presence of atrial fibrillation and the serum glucose level, the rCBV ratio on PWI (OR 1.07; 95% CI 1.02 to 1.12; p<0.01) was a significant independent indicator of ER.

Conclusions The results of this study suggest that the rCBV ratio on PWI might serve as a useful indicator of ER after IV t-PA administration.

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