Ying Zhou1, Ruiting Zhang1, Sheng Zhang1, Shenqiang Yan1, Ze Wang2,3,4, Bruce C V Campbell5, David S Liebeskind6, Min Lou7. 1. Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China. 2. Center for Cognition and Brain Disorders, Institutes of Neurological Science, Hangzhou Normal University, Hangzhou, China. 3. Affiliated Hospital of Hangzhou Normal University, Hangzhou, China. 4. Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China. 5. Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. 6. Los Angeles Stroke Center, University of California, Los Angeles, CA, USA. 7. Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China. loumingxc@vip.sina.com.
Abstract
OBJECTIVES: We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion. METHODS: We retrospectively examined data in consecutive anterior circulation AIS patients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10-6 mm2/s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6 s lesion volume of ≥70% between baseline and 24 h. RESULTS: 82 patients were included. Binary logistic regression revealed that both CST-Tmax and CST-ADC volume at baseline were significantly associated with poor outcome (p < 0.05). The 24-h CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p = 0.04). CONCLUSIONS: The use of CST-Tmax in combination with CST-ADC provides prognostic information in patients considered for reperfusion therapies. KEY POINTS: • Examine the impact of corticospinal tract involvement in acute ischaemic stroke patients. • Spatially registered Tmax images can identify corticospinal tract hypoperfusion injury. • Corticospinal tract salvage through reperfusion is associated with improved outcome.
OBJECTIVES: We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion. METHODS: We retrospectively examined data in consecutive anterior circulation AISpatients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10-6 mm2/s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6 s lesion volume of ≥70% between baseline and 24 h. RESULTS: 82 patients were included. Binary logistic regression revealed that both CST-Tmax and CST-ADC volume at baseline were significantly associated with poor outcome (p < 0.05). The 24-h CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p = 0.04). CONCLUSIONS: The use of CST-Tmax in combination with CST-ADC provides prognostic information in patients considered for reperfusion therapies. KEY POINTS: • Examine the impact of corticospinal tract involvement in acute ischaemic strokepatients. • Spatially registered Tmax images can identify corticospinal tract hypoperfusion injury. • Corticospinal tract salvage through reperfusion is associated with improved outcome.
Entities:
Keywords:
Corticospinal tract; Magnetic resonance imaging; Prognosis; Stroke; Thrombolytic therapy
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