White Matter Integrity and Early Outcomes After Acute Ischemic Stroke

被引:0
|
作者
Mark R. Etherton
Ona Wu
Anne-Katrin Giese
Arne Lauer
Gregoire Boulouis
Brittany Mills
Lisa Cloonan
Kathleen L. Donahue
William Copen
Pamela Schaefer
Natalia S. Rost
机构
[1] Massachusetts General Hospital and Harvard Medical School,J. Philip Kistler Stroke Research Center, Department of Neurology
[2] Massachusetts General Hospital,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology
来源
Translational Stroke Research | 2019年 / 10卷
关键词
Ischemic stroke; Leukoaraiosis; Diffusion tensor imaging; Stroke outcomes;
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中图分类号
学科分类号
摘要
Chronic white matter structural injury is a risk factor for poor long-term outcomes after acute ischemic stroke (AIS). However, it is unclear how white matter structural injury predisposes to poor outcomes after AIS. To explore this question, in 42 AIS patients with moderate to severe white matter hyperintensity (WMH) burden, we characterized WMH and normal-appearing white matter (NAWM) diffusivity anisotropy metrics in the hemisphere contralateral to acute ischemia in relation to ischemic tissue and early functional outcomes. All patients underwent brain MRI with dynamic susceptibility contrast perfusion and diffusion tensor imaging within 12 h and at day 3–5 post stroke. Early neurological outcomes were measured as the change in NIH Stroke Scale score from admission to day 3–5 post stroke. Target mismatch profile, percent mismatch lost, infarct growth, and rates of good perfusion were measured to assess ischemic tissue outcomes. NAWM mean diffusivity was significantly lower in the group with early neurological improvement (ENI, 0.79 vs. 0.82 × 10−3, mm2/s; P = 0.02). In multivariable logistic regression, NAWM mean diffusivity was an independent radiographic predictor of ENI (β = − 17.6, P = 0.037). Median infarct growth was 118% (IQR 26.8–221.9%) despite good reperfusion being observed in 65.6% of the cohort. NAWM and WMH diffusivity metrics were not associated with target mismatch profile, percent mismatch lost, or infarct growth. Our results suggest that, in AIS patients, white matter structural integrity is associated with poor early neurological outcomes independent of ischemic tissue outcomes.
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页码:630 / 638
页数:8
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