ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic stroke patients

J Cereb Blood Flow Metab. 2018 Mar;38(3):382-392. doi: 10.1177/0271678X17697339. Epub 2017 Mar 7.

Abstract

The purpose of this study was to develop and evaluate a scoring system for assessing reperfusion status based on arterial spin labeled (ASL) perfusion MRI in acute ischemic stroke (AIS) patients receiving thrombolysis and/or endovascular treatment. Pseudo-continuous ASL with background suppressed 3D GRASE was acquired along with DWI in 90 patients within 24 h post-treatment. An automatic reperfusion scoring system (auto-RPS) was devised based on the Alberta Stroke Program Early CT Score (ASPECTS) template, and compared with manual RPS and DWI-ASPECTS. TICI (thrombolysis in cerebral infarction) scores were graded in 48 patients who received endovascular treatment. Favorable outcomes were defined by a modified Rankin Scale score of 0-2 at three months. Auto-RPS was positively correlated with DWI-ASPECTS (ρ = 0.6, P < 0.001) and was on average 1 point lower than DWI-ASPECTS ( P < 0.001). The area under the receiver operating characteristic curve for discriminating poor functional outcome (n = 90) was 0.75 (95% CI, 0.64-0.86) for manual RPS, 0.85 (95% CI, 0.76-0.94) for auto-RPS, and 0.81 (95% CI, 0.71-0.90) for DWI-ASPECTS. Multiple logistic regression analysis in the TICI-graded patients (n = 48) showed that auto-RPS is highly associated with functional outcome (OR = 25.2, 95% CI 4.02-496, P < 0.01). Post treatment auto-RPS within 24 h provides a useful tool to predict functional outcome in AIS patients.

Keywords: Acute ischemic stroke; arterial spin labelling; recanalization; reperfusion; reperfusion injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnostic imaging*
  • Cerebral Arteries / diagnostic imaging*
  • Cerebral Infarction / diagnostic imaging
  • Diffusion Magnetic Resonance Imaging
  • Endovascular Procedures
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • ROC Curve
  • Reperfusion
  • Reperfusion Injury / diagnostic imaging*
  • Spin Labels
  • Stroke / diagnostic imaging*
  • Thrombolytic Therapy
  • Treatment Outcome

Substances

  • Spin Labels