This Article Full Text Full Text (PDF) All Versions of this Article: 39/8/2388    most recent STROKEAHA.107.510917v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kimura, K. Articles by Aoki, J. Search for Related Content PubMed PubMed Citation Articles by Kimura, K. Articles by Aoki, J. Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Thrombolysis

(Stroke. 2008;39:2388.)
© 2008 American Heart Association, Inc.

Research Letters

Large Ischemic Lesions on Diffusion-Weighted Imaging Done Before Intravenous Tissue Plasminogen Activator Thrombolysis Predicts a Poor Outcome in Patients With Acute Stroke

Kazumi Kimura, MD; Yasuyuki Iguchi, MD; Kensaku Shibazaki, MD; Yuka Terasawa, MD; Takeshi Inoue, MD; Junichi Uemura, MD Junya Aoki, MD

From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan.

Correspondence to Kazumi Kimura, MD, Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan. E-mail kimurak{at}med.kawasaki-m.ac.jp

Background and Purpose— MRI is useful for detecting early ischemic lesions before administration of tissue plasminogen activator in patients with hyperacute ischemic stroke. However, it is unclear whether early ischemic change seen on diffusion-weighted imaging (DWI) can be used to predict patient outcomes.

Methods— Consecutive patients with anterior circulation ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset were prospectively studied. The National Institutes of Health Stroke Scale score was obtained before and 7 days after tissue plasminogen activator administration. MRI, including DWI, was done before tissue plasminogen activator thrombolysis. The relationship between the DWI Alberta Stroke Programme Early CT Score (ASPECTS) and patients’ outcomes was assessed.

Results— The subjects consisted of 49 consecutive patients with stroke (27 males; mean age, 72.9±10.3 years). The median (range) of the baseline DWI ASPECTS value was 9 (3–10). Dramatic improvement was seen in one of 8 patients with an ASPECTS 5 compared with 21 of 41 patients with a DWI ASPECTS >5 (P=0.0592). On the other hand, worsening was noted more frequently in patients with a DWI ASPECTS 5 (3 of 8 patients) than in patients with an ASPECTS >5 (4 of 41 patients; P=0.0753). Bad outcome was seen more frequently in patients with a DWI ASPECTS 5 (6 of 8 patients) than in patients with a DWI ASPECTS >5 (2 of 41 patients; P<0.0001). Multivariate logistic regression analysis demonstrated that a DWI ASPECTS 5 was the only independent predictor of a bad outcome (OR, 33.4; 95% CI, 2.7 to 410.8; P=0.0062).

Conclusion— DWI ASPECTS appears to be a reliable tool for predicting bad outcome. Patients with a DWI ASPECTS >5 should be considered eligible for tissue plasminogen activator therapy.

Key Words: outcome • tissue plasminogen activator • MRI • DWI • acute stroke

This article has been cited by other articles:

				K. Toyoda, M. Koga, M. Naganuma, Y. Shiokawa, J. Nakagawara, E. Furui, K. Kimura, H. Yamagami, Y. Okada, Y. Hasegawa, et al. Routine Use of Intravenous Low-Dose Recombinant Tissue Plasminogen Activator in Japanese Patients: General Outcomes and Prognostic Factors From the SAMURAI Register Stroke, November 1, 2009; 40(11): 3591 - 3595. [Abstract] [Full Text] [PDF]

				O. C. Singer, W. Kurre, M. C. Humpich, M. W. Lorenz, A. Kastrup, D. S. Liebeskind, G. Thomalla, J. Fiehler, J. Berkefeld, T. Neumann-Haefelin, et al. Risk Assessment of Symptomatic Intracerebral Hemorrhage After Thrombolysis Using DWI-ASPECTS Stroke, August 1, 2009; 40(8): 2743 - 2748. [Abstract] [Full Text] [PDF]