Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion

Abstract

BACKGROUND AND PURPOSE:The benefit of recanalization in basilar artery occlusion (BAO) has been established. The baseline extent of brain stem damage may also influence the outcome. We investigated whether a baseline diffusion-weighted imaging (DWI) score may provide additional prognostic value in BAO.

Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

“…18 More recently, authors [15][16][17] have studied patients with a posterior circulation stroke by using various neuroradiologic scales of DWI. In 2010, Tei et al 17 evaluated the usefulness of the pc-ASPECTS on DWI to predict functional outcome in 132 patients with a posterior circulation infarction.…”

“…Using a 10-point semiquantitative DWI score, they found that in univariate analyses, all patients with a lesion score of Ͼ3 had a worse outcome or died (P ϭ .026). Cho et al 16 analyzed 29 patients treated with endovascular procedures for ABAO and found that the brain stem score was the only independent baseline predictor of clinical outcome. In contrast to previous studies 13, 14 on vertebrobasilar ischemic stroke, they found a significant association between the DWI brain stem lesion score and the baseline NIHSS score, as well as between the presence and length of a coma before treatment.…”

“…These findings suggest that the main benefit of DWI analysis remains the brain stem, essentially because involvement of the brain stem, in particular the pons and midbrain, is critical to functional outcome. The use of a brain stem score to identify a predictor of clinical outcome had been tested by Cho et al 16 Their score is based on arterial territory segmentation of the medulla, pons, and midbrain, as described by Tatu et al 22 However, they did not determine the optimal cutoff score, according to ROC, to predict outcome. Moreover, MR imaging analysis of the exact volume of a lesion in a brain stem score appears difficult to assess routinely as a standard score in an acute phase, especially by using DWI sequences, which have poor spatial resolution.…”

“…13,14 More recently, investigators have studied the functional outcome and extent of lesions in patients with a posterior circulation infarction by diffusion-weighted MR imaging. [15][16][17] Because of the high attenuation of the anatomic architecture in the brain stem, lesion location rather than lesion volume can be critical in determining functional outcome after a posterior circulation infarction, especially when the brain stem is involved. 18 The aim of our study was to test the reproducibility and validity of a novel baseline and easy-to-use prethrombectomy DWI brain stem score (BSS) in 31 consecutive patients with proved ABAO and treated within 24 hours of symptom onset, by using mechanical thrombectomy.…”

Multimodal imaging protocols and their predictive role in acute stroke functional outcome

“…Однако изолированная окклюзия ВСА (без вовлечения пе-редней хориоидальной артерии) независимо ассо-циирована с БФИ [56][57][58][59][60][61]. Установлено, что шкалы BASIS и CBS превосходят ASPECTS в отношении прогнозирования ФИ, при этом CBS имеет боль-шую чувствительность, а BASIS -специфичность [62][63][64][65]. ФИ напрямую коррелирует как со степе-нью коллатерального кровотока, так и реканализа-цией артерий, так как от них напрямую зависит КОИ [66][67][68][69][70].…”