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European Radiology

, Volume 27, Issue 12, pp 5280–5289 | Cite as

Impact of perfusion lesion in corticospinal tract on response to reperfusion

  • Ying Zhou
  • Ruiting Zhang
  • Sheng Zhang
  • Shenqiang Yan
  • Ze Wang
  • Bruce C. V. Campbell
  • David S. Liebeskind
  • Min Lou
Magnetic Resonance

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.

Keywords

Stroke Thrombolytic therapy Magnetic resonance imaging Prognosis Corticospinal tract 

Abbreviations

ADC

Apparent diffusion coefficient

AIF

Arterial input function

AIS

Acute ischaemic stroke

CI

Confidence interval

CRR

Corticospinal tract reperfusion rate

CST

Corticospinal tract

CST-ADC

Volumes of corticospinal tract involvement by apparent diffusion coefficient < 620 × 10−6 mm2/s

CST-Tmax

Volumes of corticospinal tract involvement by time to maximum of tissue residue function > 6 s

DTI

Diffusion tensor imaging

DWI

Diffusion-weighted imaging

HT

Haemorrhage transformation

MNI

Montreal Neurology Institute

mNIHSS

Motor subscore of the National Institute of Health Stroke Scale

mRS

Modified Rankin scale

MRP

Magnetic resonance perfusion

NIHSS

National Institute of Health Stroke Scale

OR

Odds ratio

ROC

Receiver operating characteristic

RR

Reperfusion rate

rt-PA

Recombinant tissue-type plasminogen activator

SVD

Singular value deconvolution

SHT

Symptomatic haemorrhage transformation

T1WI

T1-weighted imaging

Tmax

Time to maximum of tissue residue function

Notes

Acknowledgments

We are grateful for the support from our patients.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Min Lou.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Liebeskind is among the consultant/advisory board (modest) of Stryker and Covidien. Other authors have no actual or potential conflicts of interest to disclose.

Funding

This study has received funding by the National Natural Science Foundation of China (81622017 & 81471170) and the National Key Research and Development Program of China (2016YFC1301500).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2017_4868_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Ying Zhou
    • 1
  • Ruiting Zhang
    • 1
  • Sheng Zhang
    • 1
  • Shenqiang Yan
    • 1
  • Ze Wang
    • 2
    • 3
    • 4
  • Bruce C. V. Campbell
    • 5
  • David S. Liebeskind
    • 6
  • Min Lou
    • 1
  1. 1.Department of Neurologythe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
  2. 2.Center for Cognition and Brain Disorders, Institutes of Neurological ScienceHangzhou Normal UniversityHangzhouChina
  3. 3.Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
  4. 4.Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouChina
  5. 5.Department of Medicine and Neurology, Royal Melbourne HospitalUniversity of MelbourneParkvilleAustralia
  6. 6.Los Angeles Stroke Center, University of CaliforniaLos AngelesUSA

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