Early Diffusion-Weighted Imaging Reversal After Endovascular Reperfusion Is Typically Transient in Patients Imaged 3 to 6 Hours After Onset

Author:

Inoue Manabu1,Mlynash Michael1,Christensen Soren1,Wheeler Hayley M.1,Straka Matus1,Tipirneni Aaryani1,Kemp Stephanie M.1,Zaharchuk Greg1,Olivot Jean-Marc1,Bammer Roland1,Lansberg Maarten G.1,Albers Gregory W.1

Affiliation:

1. From the Stanford Stroke Center, Stanford University School of Medicine, CA.

Abstract

Background and Purpose— The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient. Methods— MRI with DWI perfusion imaging was performed before (DWI 1) and within 12 hours after (DWI 2) endovascular treatment; follow-up MRI was obtained on day 5. Both DWIs were coregistered to follow-up MRI. Early DWI reversal was defined as the volume of the DWI 1 lesion that was not superimposed on the DWI 2 lesion. Permanent reversal was the volume of the DWI 1 lesion not superimposed on the day 5 infarct volume. Associations between early DWI reversal and clinical outcomes in patients with and without reperfusion were assessed. Results— A total of 110 patients had technically adequate DWI before endovascular therapy (performed median [interquartile range], 4.5 [2.8–6.2] hours after onset); 60 were eligible for this study. Thirty-two percent had early DWI reversal >10 mL; 17% had sustained reversal. The median volume of permanent reversal at 5 days was 3 mL (interquartile range, 1.7–7.0). Only 2 patients (3%) had a final infarct volume that was smaller than their baseline DWI lesion. Early DWI reversal was not an independent predictor of clinical outcome and was not associated with early reperfusion. Conclusions— Early DWI reversal occurred in about one third of patients after endovascular therapy; however, reversal was often transient and was not associated with a significant volume of tissue salvage or favorable clinical outcome.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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