(Stroke. 2000;31:2597.)
© 2000 American Heart Association, Inc.
Original Contributions |
Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome?
A Multivariable Analysis
From the Stanford Stroke Center, Department of Neurology and Neurological Sciences (V.N.T., M.G.L., G.W.A.), and Department of Radiology, Section of Neuroradiology (C.B., M.P.M., M.E.M.), Stanford University Medical Center, Palo Alto, Calif, and Department of Neurology, UZ Gasthuisberg, Katholieke Universiteit Leuven (Belgium) (V.N.T.).
Correspondence to Vincent N. Thijs, MD, Stanford Stroke Center, Stanford University Medical Center, 701 Welch Rd, Bldg B, Suite 325, Palo Alto, CA 94304-0117. E-mail vthijs{at}stanford.edu
Background and Purpose—The heterogeneity of stroke makes outcome prediction difficult. Neuroimaging parameters may improve the predictive value of clinical measures such as the National Institutes of Health Stroke Scale (NIHSS). We investigated whether the volume of early ischemic brain lesions assessed with diffusion-weighted imaging (DWI) was an independent predictor of functional outcome.
Methods—We retrospectively selected patients with nonlacunar
ischemic stroke in the anterior circulation from 4 prospective
Stanford Stroke Center studies evaluating early MRI. The baseline NIHSS
score and ischemic stroke risk factors were assessed. A DWI MRI
was performed within 48 hours of symptom onset. Clinical
characteristics and early lesion volume on DWI were compared between
patients with an independent outcome (Barthel Index score 
85) and a
dependent outcome (Barthel Index score <85) at 1 month. A logistic
regression model was performed with factors that were significantly
different between the 2 groups in univariate
analysis.
Results—Sixty-three patients fulfilled the entry criteria. One
month after symptom onset, 24 patients had a Barthel Index score <85
and 39 had a Barthel Index score 85. In univariate
analysis, patients with independent outcome were younger, had
lower baseline NIHSS scores, and had smaller lesion volumes on DWI. In
a logistic regression model, DWI volume was an independent predictor of
outcome, together with age and NIHSS score, after correction for
imbalances in the delay between symptom onset and MRI.
Conclusions—DWI lesion volume measured within 48 hours of symptom onset is an independent risk factor for functional independence. This finding could have implications for the design of acute stroke trials.
Key Words: magnetic resonance imaging, diffusion-weighted • stroke, acute • stroke outcome
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