Predictive Value Of Dynamic Contrast-enhanced MRI For The Functional Outcome Of Acute Ischemic Stroke

Part I Permeability of Blood-brain Barrier Measured by Dynamic Contrast-enhanced MRI Predicts Functional Outcome of StrokeObjectives:This study aimed to evaluate the association between the permeability of blood-brain barrier(BBB)and adverse functional outcome by dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in acute ischemic stroke patients after reperfusion therapy.Methods:Patients with acute anterior ischemic stroke and reperfusion therapy were recruited and underwent DCE-MRI.Adverse functional outcome was defined as the modified Rankin Score(mRS)>2 at 3-month after discharge.The association between DCE-MRI measurements and adverse functional outcome was analyzed using logistic regression analysis.Receiver operating characteristic(ROC)analysis was performed to calculate the area-under-the-curve(AUC)of DCE-MRI measurements in predicting adverse functional outcome.Results:In total,80 subjects(age:64.0±10.7 years;53 men)were enrolled.The median value of the permeability of BBB in patients with adverse functional outcome group was significantly higher than that in those without(5.3 IQR(4.0-9.4)vs.3.0 IQR(2.0-4.9),P<0.001).No significant differences were found in other DCE-MRI measurements(all p>0.05).The rKtrans value was significantly associated with adverse functional outcome before(odds ration[OR],1.255;95%confidence interval[CI],1.089-1.459,P=0.002)and after(OR,1.268;95%CI,1.063-1.512,P=0.008)adjusting for confounding factors.The AUC of rKtrans in predicting adverse functional outcome was 0.762(sensitivity,75.0%;specificity,68.2%),and this value increased to 0.80(sensitivity,75.0%;specificity,72.7%)after combined with infarct volume and NIHSS.Conclusions:The permeability of BBB in acute ischemic stroke patients measured by DCE-MRI might be a useful predictor for short-term adverse functional outcome after reperfusion therapy.Part ? Combining DCE-MRI and NLR to Predict Clinical Outcomes in Acute Ischemic Stroke PatientsObjective:To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),neutrophil and lymphocyte ratios(NLR)at admission and the combination of them for clinical outcome of acute ischemic stroke patients.Methods:A total of 58 patients with acute ischemic stroke were admitted to this study(53 men,27 women).Baseline clinical characteristics and blood routine examinations of every patient was recorded within 24 hours after admission,then neutrophil and lymphocyte counts were obtained respectively,and the NLR was calculated.The DCE-MRI of brain was performed for all patients within 24-72 hours after the onset of symptoms.ROIs were plotted at the maximum level of the lesions and the mirror areas in the contralateral hemisphere,quantitative parameters Kep and Ve of lesions and mirror areas were measured.The relative values(rKtrans?rKep?rVe)of infarction lesions to mirror areas were calculated.According to the modified Rankin scale(mRS)scores at 90 days after discharge,patients were divided into good and adverse clinical outcome groups(44/36).The association between risk factors and adverse clinical outcome was analyzed using logistic regression analysis.Receiver operating characteristic(ROC)curve was performed to evaluate the predictive value of each parameter and its combination.Results:(1)The NIHSS score,NLR at admission and rKtrans were independently associated with adverse clinical outcome(OR,1.031?1.663?1.255,95%CI,0.966—1.100?1.214—2.277?1.084-1.459,all P<0.05).(2)In predicting adverse clinical outcome,the AUC of NLR at admission and rKtrans were 0.75 and 0.76,respectively,and the AUC increased to 0.82 after combining with each other.Conclusion:The NLR at admission and the parameter rKtrans derived from DCE-MRI could predict the adverse clinical outcome of acute ischemic stroke patients.The combination of NLR and DCE-MRI may further improve the predictive efficacy.