Predictive value of Alberta stroke program early CT score for perfusion weighted imaging - diffusion weighted imaging mismatch in stroke with middle cerebral artery occlusion

Abstract

This study aimed to quantitatively assess the consistency and correlation between perfusion weighted imaging (PWI)/ diffusion weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) mismatch and PWI/DWI mismatch. Sixty-eight acute ischemic stroke with middle cerebral artery occlusion who underwent magnetic resonance imaging before thrombectomy were eligible. DWI volume, PWI volume and PWI-DWI mismatch were measured. DWI-, PWI-, PWI-DWI ASPECTS were evaluated. Statistical analysis was performed to compare the correlation between volume and ASPECTS of DWI-, PWI- and PWI-DWI mismatch. Receiver operating characteristic curve analysis was used to assess the predictive value of the PWI-DWI ASPECTS mismatch for the occurrence of PWI-DWI mismatch in acute ischemic stroke patients with middle cerebral artery occlusion. Of 68 patients, the DWI volume, PWI volume and PWI-DWI mismatch volume were (27.76 ± 17.53) mL, (167.09 ± 59.64) mL and (139.33 ± 58.18) mL respectively. DWI-ASPECTS was 6.75 ± 1.90 with the interobserver agreement was κ=0.98 (95% CI, 0.95–0.99); PWI-ASPECTS was 3.09 ± 2.11 with the interobserver agreement was κ=0.95 (95% CI, 0.91–0.99); PWI-DWI ASPECTS mismatch was 6.75 ± 1.90. Spearman's rank correlation analysis revealed that PWI-DWI mismatch volume was negatively correlated with PWI-DWI ASPECTS mismatch (r = −0.802; P = .000). Receiver operating characteristic analysis showed that when the PWI-DWI ASPECTS mismatch cut point was ≥ 2, the under curve of PWI-DWI ASPECTS mismatch for predicting PWI-DWI mismatch was 0.954 (95%CI, 0.911–0.998), with the sensitivity and specificity were 84.00% and 100% respectively. PWI-DWI ASPECTS mismatch may represent a convenient surrogate for penumbra in clinical trials.

Evaluation of collateral circulation and short-term prognosis of patients with acute cerebral infarction by perfusion-weighted MRI

“…Within minutes of a stroke, a high signal can be observed on PWI with a prolonged peak time (35). PWI can semi-quantitatively study the changes of blood flow after cerebral infarction, and provide necessary hemodynamic parameters (36). Through the comprehensive analysis of these parameters, a specific assessment of blood supply in the area of cerebral infarction can be made.…”

Neuroimaging Modalities Used for Ischemic Stroke Diagnosis and Monitoring

“…PWI measures perfusions of the cerebrum using the evaluation of hemodynamic parameters like mean transit time, cerebral blood flow and cerebral blood volume [52]. The DWI/PWI mismatch concept has been used to define the presence of hypoperfused ischemic penumbra in PWI and the infarct core in DWI [52,60,61]. It has been tested as a thrombolysis selection marker and can also provide a prediction of the final infarct area, which can be used to reduce variability between cases in studying the treatment outcome [62].…”