Diffusion-weighted imaging as predictor of acute ischemic stroke etiology

Author:

Brunser Alejandro Michel1ORCID,Mansilla Eloy2ORCID,Navia Victor2ORCID,Mazzon Enrico3ORCID,Rojo Alexis4ORCID,Cavada Gabriel5ORCID,Olavarría Verónica3ORCID,Venturelli Paula Muñoz6ORCID,Lavados Pablo Manuel.2ORCID

Affiliation:

1. Clínica Alemana de Santiago, Chile; Clínica Alemana de Santiago, Chile; Universidad del Desarrollo, Chile

2. Clínica Alemana de Santiago, Chile; Universidad del Desarrollo, Chile

3. Clínica Alemana de Santiago, Chile; Universidad del Desarrollo, Chile; Clínica Alemana de Santiago, Chile

4. Hospital Clínico Herminda Martin de Chillán, Chile

5. Clínica Alemana de Santiago, Chile

6. Clínica Alemana de Santiago, Chile; Universidad del Desarrollo, Chile; Universidad del Desarrollo, Chile

Abstract

Abstract Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion-weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.

Publisher

FapUNIFESP (SciELO)

Subject

Neurology,Neurology (clinical)

Reference18 articles.

1. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population based study;Kolominsky-Rabas PL;Stroke,2001

2. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST;Adams Jr HP;Trial of Org 10172 in Acute Stroke Treatment. Stroke,1993

3. Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct;Brunser AM;Stroke,2013

4. Diffusion-weighted imaging determinants for acute ischemic stroke diagnosis in the emergency room;Brunser AM;Neuroradiology,2018

5. Multiple acute stroke syndrome: marker of embolic disease?;Baird AE;Neurology,2000

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