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  • Low relative diffusion weighted image signal intensity can predict good prognosis after endovascular thrombectomy in patients with acute ischemic stroke

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Neuroimaging
Original research
Low relative diffusion weighted image signal intensity can predict good prognosis after endovascular thrombectomy in patients with acute ischemic stroke
  1. Fumihisa Kishi1,
  2. Ichiro Nakagawa1,
  3. HunSoo Park1,
  4. Masashi Kotsugi1,
  5. Kaoru Myouchin2,
  6. Yasushi Motoyama1,
  7. Hiroyuki Nakase1
  1. 1 Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
  2. 2 Department of Radiology, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
  1. Correspondence to Dr Ichiro Nakagawa, Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara 634-8522, Japan; nakagawa{at}naramed-u.ac.jp

Abstract

Background It is vital to identify a surrogate last-known-well time to perform proper endovascular thrombectomy in acute ischemic stroke; however, no established imaging biomarker can easily and quickly identify eligibility for endovascular thrombectomy and predict good clinical prognosis.

Objective To investigate whether low relative diffusion-weighted imaging (DWI) signal intensity can be used as a predictor of good clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke.

Methods We retrospectively identified consecutive patients with acute ischemic stroke who were treated with endovascular thrombectomy within 24 hours of the last-known-well time and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b). Relative DWI signal intensity was calculated as DWI signal intensity in the infarcted area divided by DWI signal intensity in the contralateral hemisphere. Good prognosis was defined as a modified Rankin Scale score of 0–2 at 90 days after stroke onset (good prognosis group).

Results 49 patients were included in the analysis. Relative DWI signal intensity was significantly lower in the group with good prognosis than in the those with poor prognosis (median (IQR) 1.32 (1.27–1.44) vs 1.56 (1.43–1.66); p<0.01), and the critical cut-off value for predicting good prognosis was 1.449 (area under the curve 0.78). Multiple logistic regression analysis revealed association of good prognosis after endovascular thrombectomy with low relative DWI signal intensity (OR=6.84; 95% CI 1.13 to 41.3; p=0.04).

Conclusions Low relative DWI signal intensity was associated with good prognosis after endovascular thrombectomy. Its ability to predict good clinical outcome shows potential for determining patient suitability for endovascular thrombectomy.

  • thrombectomy
  • stroke
  • MRI

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017583

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors IN and FK conceived the study, analyzed and interpreted the data, and drafted the manuscript FK, IN, HSP, MK, KM, YM, HN edited the manuscript. All authors have reviewed and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.