Article Figures & Data
Figures
- Fig 1.
Image postprocessing and segmentation of cerebral venous structures based on SWI phase images. The SWI phase image (A) was used to calculate the number of voxels of superficial cerebral veins (B) and deep cerebral veins (C) for quantification after segmentation. The asymmetry index of cerebral veins was set as a ratio of voxel numbers of cerebral veins between the ipsilateral and contralateral side.
- Fig 2.
The AI score was positively correlated with the frequency of favorable outcome in patients with early reperfusion. The optimal AI score was set as 1.75 based on maximizing the Youden index (sensitivity, 83%; specificity, 67%; Youden index, 53%) for predicting favorable outcome in patients with early reperfusion. R (+) indicates the number of patients with early reperfusion; R (−), the number of patients without early reperfusion.
- Fig 3.
Representative pretreatment MR imaging in patients receiving thrombolysis. The first column on the left depicts time-of-flight MR angiography; the second and third columns depict phase images of susceptibility-weighted imaging and an enlarged view focusing on the deep cerebral veins. The right column depicts Tmax maps of perfusion-weighted MR imaging. Patients with a high AI score (A, TIMI = 1, AI score = 1.92, PWI lesion volume = 51 mL) had a lower TIMI score and larger PWI lesion volume than those with low AI scores (B, TIMI = 3, AI score = 1.19, PWI lesion volume = 0 mL).
Tables
- Table 1:
Univariate analysis of the baseline variables according to the asymmetry index of cerebral veinsa
Variable High AI (n = 27) Low AI (n = 27) P Value Mean age (yr) 69 ± 13 69 ± 14 .926 Sex, female (%) 8 (30%) 13 (48%) .264 Serum glucose (mmol/L) 141 ± 41 159 ± 72 .268 Systolic BP (mm Hg) 156 ± 19 153 ± 24 .653 Time to imaging (min) 175 ± 58 186 ± 68 .514 Time to treatment (min) 222 ± 68 235 ± 60 .448 Baseline NIHSS score 15 (6–18) 9 (5–14) .096 Stroke risk factors Atrial fibrillation (%) 13 (48%) 11 (41%) .785 Hypertension (%) 20 (74%) 18 (67%) .766 Diabetes mellitus (%) 7 (26%) 9 (33%) .766 Hyperlipidemia (%) 11 (41%) 9 (33%) .779 Current smoking (%) 11 (41%) 4 (15%) .066 Coronary heart disease (%) 7 (26%) 8 (30%) 1.000 Hyperhomocysteinemia (%) 9 (33%) 7 (26%) .766 White blood cell/mm3 7.1 ± 2.2 8.3 ± 2.4 .052 PT (sec) 12.7 ± 0.9 12.4 ± 1.4 .368 APTT (sec) 27.6 ± 5.6 25.3 ± 3.4 .066 INR 1.06 ± 0.08 1.03 ± 0.12 .325 Fibrinogen level (g/L) 7.7 ± 24.9 2.8 ± 0.9 .313 Serum creatinine level (mg/dL) 0.82 ± 0.14 0.99 ± 0.93 .366 Serum urea nitrogen level (mg/dL) 16.2 ± 5.1 16.1 ± 4.3 .909 TIMI grading 1 (0–1) 2 (0–3) .002b Sites of occlusion .042b Proximal 22 14 Distal 5 13 DWI lesion volume (mL) 37 ± 57 15 ± 33 .091 PWI lesion volume (mL) 120 ± 83 58 ± 67 .004b 24-Hour DWI lesion volume (mL) 66 ± 82 35 ± 69 .131 Hemorrhagic transformation (%) 11 (41%) 7 (26%) .387 HI 7 (26%) 5 (19%) .745 PH 4 (15%) 2 (33%) .669 sICH 1 (4%) 2 (7%) 1.000 Favorable outcome 17 (63%) 13 (48%) .412 Note:—BP indicates blood pressure; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; HI, hemorrhagic infarction; PH, parenchymal hematoma; sICH, symptomatic intracerebral hemorrhage.
↵a Table cells express results in mean ± SD for normally distributed continuous variables, n (%) for dichotomous variables, and median (interquartile range) for ordinal variables and non-normally distributed continuous variables, respectively.
↵b P < .05.
- Table 2:
Different outcomes in patients with or without SWI-DWI mismatch based on reperfusion
Reperfusion No Reperfusion Total Favorable Outcome Total Favorable Outcome SWI-DWI Mismatch (n = 18) 11 10 (91%) 7 4 (57%) Non-SWI-DWI mismatch (n = 36) 14 6 (43%) 22 10 (45%) P value .033 .682 - Table 3:
The sensitivity, specificity, and accuracy between SWI-DWI and PWI-DWI mismatchesa
Sensitivity Specificity Accuracy AUC SWI-DWI mismatch 46.7 55.6 63.0% 0.511 Standard PWI-DWI mismatch 63.3 8.3 37.0% 0.338 Optimal PWI-DWI mismatch 60.0 25.0 44.4% 0.425 Target PWI-DWI mismatch 63.3 38.9 48.1% 0.463 Note:—AUC indicates area under the curve.
↵a Accuracy is the proportion of true results (both true-positives and true-negatives) in the population. Standard PWI-DWI mismatch was defined as PWI/DWI ≥ 1.2, PWI-DWI ≥ 10 mL. Optimal PWI-DWI mismatch was defined as PWI/DWI ≥ 2.6 and PWI-DWI ≥ 10 mL. Target PWI-DWI mismatch was defined as PWI/DWI ≥ 1.2, PWI-DWI ≥10 mL, PWI (Tmax ≥ 8 seconds) ≤ 100 mL, and DWI ≤ 100 mL.
