Abstract T P36: DWI Lesion Size but Not FLAIR Status Alone is Associated With Early Clinical Outcome in Stroke Patients Undergoing MRI Prior to Systemic Thrombolysis
Objectives: Treatment of ischemic stroke holds the risk of intracerebral hemorrhage (ICH) due to systemic thrombolysis, often associated with poor functional outcome. Hence, parameters allowing prediction from deleterious courses are of increasing interest. We have recently shown that fluid-attenuated inversion recovery (FLAIR)-positive lesions seen on baseline magnetic resonance imaging (MRI) are associated with an increased rate on ICH. This study asked for the relationship between findings originating from baseline MRI and the clinical course.
Methods: Using a multi-parameter hospital-based registry, the diffusion-weighted imaging (DWI) and FLAIR on baseline MRI of 122 ischemic stroke patients were analyzed for DWI lesion size and FLAIR-positive lesions within diffusion-restricted areas. These data originated from MRI that had been done prior to treatment with tissue plasminogen activator (tPA) within 3 hours from symptom onset, whereas computed tomography performed within 24 hours post-treatment served for detection of ICH. The early clinical outcome was assessed at hospital discharge using Barthel index (BI), modified Rankin scale (mRS) and National Institutes of Health Stroke Scale (NIHSS).
Results: Out of 97 patients providing sufficient imaging quality, FLAIR-positive lesions were present in 25 patients (25.8 %) and ICH occurred in 32 patients (33.0 %). Remarkably, patients with or without FLAIR-positive lesions did not differ concerning the clinical outcome (BI, P=0.055; mRS, P=0.106; NIHSS, P=0.295). Patients exhibiting an initial DWI lesion size of at least 1/3 of vascular territory demonstrated an increased NIHSS (P=0.031), increased mRS (P=0.011) and decreased BI (P=0.004) when compared to patients with smaller lesion sizes. As expected, more severe clinical affection was found in patients suffering from ICH (BI, P=0.013; mRS, P=0.001; NIHSS, P=0.016). Conclusions: In ischemic stroke patients treated with tPA, initial DWI lesion size was found to be closely associated with early clinical outcome, which was, however, not seen for FLAIR positivity. Therefore, a combination of both DWI lesion size and FLAIR status might represent an addition tool to enhance safety for stroke patients undergoing systemic thrombolysis.
Author Disclosures: C. Hobohm: None. S. Budig: None. D. Fritzsch: None. D. Michalski: None.
- © 2015 by American Heart Association, Inc.