on September 27, 2007
Published online before print September 27, 2007, doi: 10.1161/STROKEAHA.107.485995
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Submitted on February 22, 2007
From the Section on Stroke Diagnostics and Therapeutics (J.G.M., L.L.L., J.W.T., M.L., P.D.S., D.-W.K., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; NorthEast Neurology (J.W.T.), NorthEast Medical Center, Concord, NC; Neurologische Klinik (P.D.S.), Universitätsklinikum Erlangen, Erlangen, Germany; and the Department of Neurology (D.-W.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. * To whom correspondence should be addressed. E-mail: merinoj{at}ninds.nih.gov.
Background and Purpose—A change in acute-to-chronic lesion volume has been proposed as a biomarker for stroke therapies. The objectives of this study were to determine the magnitude of lesion volume change after standard treatment with tissue plasminogen activator and to determine whether specific volume change thresholds can discriminate clinical responders from nonresponders. Methods—We measured lesion volume on diffusion weighted at baseline and on 90-day fluid attenuated inversion recovery MRI and scored 3-month modified Rankin Scale in consecutive patients treated with tissue plasminogen activator. We identified variables associated with excellent (modified Rankin Scale 0 to 1) and independent (modified Rankin Scale 0 to 2) outcomes. Results—We included 53 patients (mean age 69 years, median baseline National Institutes of Health Stroke Scale score 7). The mean acute-to-chronic lesion volume increase was 11.7 (±7.7) cm3. In 23 patients, the chronic lesion was smaller than the baseline lesion. At 3 months, 32 patients had an excellent clinical outcome. Dichotomous volume change variables associated with outcome included decrease in volume Conclusions—In patients given standard tissue plasminogen activator therapy, changes in lesion volume are associated with clinical outcome, and threshold lesion volumes can differentiate excellent and poor outcome, suggesting these as a potential marker of outcome.
Revised on April 25, 2007
Accepted on April 26, 2007
Lesion Volume Change After Treatment With Tissue Plasminogen Activator Can Discriminate Clinical Responders From Nonresponders
José G. Merino MD, MPhil*;
30% (P=0.004) and volume increase 5 cm3 (P=0.002).
Key words: acute stroke • brain imaging • brain infarction • MRI • thrombolysis • thrombolytic RX