Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke

Abstract

BackgroundMalignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large‐vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large‐vessel occlusion regardless of reperfusion therapy.Methods and ResultsConsecutive acute ischemic stroke patients with anterior large‐vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and diffusion‐weighted imaging lesion ischemic core volume (VolDWI) were measured in acute ischemic stroke patients with large‐vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3 months, and optimal DWI‐ASPECTS and VolDWI for unfavorable outcome were assessed. In total, 198 patients (111 men, 77±13 years old) were enrolled. Median DWI‐ASPECTS was 7 (5‐9), and median VolDWI was 55 (6‐134) mL. Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for DWI‐ASPECTS and VolDWI were 4 (area under the curve 0.78, P<0.01; sensitivity 0.71, specificity 0.75) and 71 mL (area under the curve 0.80, P<0.01; sensitivity 0.76, specificity 0.77), respectively.ConclusionsThe cutoff values for our redefined malignant profile were DWI‐ASPECTS 4 and VolDWI 71 mL with no selection bias for reperfusion therapy in the real‐world clinical practice.Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02251665

Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion‐weighted imaging lesions

“…Thus, some of these patients might not have imaging predictors of MMI. Although a DWI-ASPECTS ≤ 6 has previously been shown to be associated with a DWI lesion volume >100 mL [11], a recent study demonstrated a significant divergence between DWI-ASPECTS and DWI lesion volume assessment when DWI-ASPECTS is <7 [16]. Indeed, in our study, almost half of the patients with a DWI-ASPECTS ≤ 6 had a DWI lesion volume <82 mL.…”

Reliability and Reproducibility of the Diameters Method in Rapid Determination of Acute Infarct Volume in Magnetic Resonance Diffusion-Weighted Imaging

“…Diffusion-weighted imaging (DWI) has a higher diagnostic value for ischemic stroke, which provides therapeutic considerations for ischemic stroke intervention [3,4]. Recent studies have shown that a pretreatment lesion volume >70 mL is highly predictive of a poor clinical outcome, while 100 mL lesion volume has also been reported to be predictive of symptomatic hemorrhagic transformation [5][6][7].…”

Cerebral embolism accompanied by remarkable diffusion-weighted imaging reversal in a 10 month-old infant with congenital heart disease

“…DWI-ASPECTS and the core volume show a weak correlation when DWI-ASPECTS is under 6, which is approximately >33 ml in the adult ischemic stroke population [ 6 ]. Blurry DWI lesions are sometimes biased by ASPECT scoring, and on the other hand, are underestimated by automated software.…”