AUTHOR=Xiao Jingjing , Liang Huazheng , Wang Yue , Wang Shaoshi , Wang Yi , Bi Yong 

TITLE=Risk Factors of Hypoperfusion on MRI of Ischemic Stroke Patients Within 7 Days of Onset

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.668360

DOI=10.3389/fneur.2021.668360

ISSN=1664-2295

ABSTRACT=<p><bold>Objective:</bold> Hypoperfusion is an important factor determining the prognosis of ischemic stroke patients. The present study aimed to investigate possible predictors of hypoperfusion on MRI of ischemic stroke patients within 7 days of stroke onset.</p><p><bold>Methods:</bold> Ischemic stroke patients, admitted to the comprehensive Stroke Center of Shanghai Fourth People's Hospital affiliated to Tongji University within 7 days of onset between January 2016 and June 2017, were recruited to the present study. Magnetic resonance imaging (MRI), including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days of the symptom onset. Time to maximum of the residue function (<italic>T</italic><sub><italic>max</italic></sub>) maps were automatically evaluated using the RAPID software. The volume of hypoperfusion was measured outside the infarct area based on ADC &lt; 620 × 10<sup>−6</sup> mm<sup>2</sup>/s. The 90 d mRS score was assessed through either clinic visits or telephone calls. Multivariate step-wise analysis was used to assess the correlation between MR findings and clinical variables, including the demographic information, cardio-metabolic characteristics, and functional outcomes.</p><p><bold>Results:</bold> Among 635 patients admitted due to acute ischemic stroke within 7 days of onset, 241 met the inclusion criteria. Hypoperfusion volume of 38 ml was the best cut-off value for predicting poor prognosis of patients with cerebral infarction (90 d-mRS score ≥ 2). The incidences of MR perfusion <italic>T</italic><sub><italic>max</italic></sub> &gt; 4–6 s maps with a volume of 0–38 mL or &gt;38 mL were 51.9% (125/241) and 48.1% (116/241), respectively. Prior stroke and vascular stenosis (≥70%) were associated with MR hypoperfusion. Multivariate step-wise analysis showed that prior stroke and vascular stenosis (≥70%) were risk factors of <italic>T</italic><sub><italic>max</italic></sub> &gt; 4–6 s maps, and the odds ratios (OR) were 3.418 (adjusted OR 95% CI: 1.537–7.600), and 2.265 (adjusted OR, 95% CI: 1.199–4.278), respectively.</p><p><bold>Conclusion:</bold> Our results suggest that prior stroke and vascular stenosis (≥70%) are strong predictors of hypoperfusion in patients with acute ischemic stroke within 7 days of stroke onset.</p>