Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

S.S. Lu; R.R. Wu; Y.Z. Cao; X.Q. Xu; Z.Y. Jia; H.B. Shi; S. Liu; F.Y. Wu

doi:10.3174/ajnr.A7741

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FIG 1.
Flow chart for patient selection.
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FIG 2.
A, Differences in ASPECTS-NWU between patients with an mRS score of 0–6 at 90 days. The value of ASPECTS-NWU significantly correlates with the 90-day mRS scores (r = 0.451, P < .001). B, Boxplots display differences in ASPECTS-NWU between patients with favorable prognosis (mRS ≤2) and patients with poor prognosis (mRS > 2). Significantly lower values of ASPECTS-NWU can be observed in patients with good prognosis when compared to those with poor prognosis, regardless of the 6-hour time window. The asterisks indicate P < .001.
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FIG 3.
ROC curves for ASPECTS-NWU, age, and NIHSS_admission and their combinations with vessel recanalization for predicting a favorable prognosis (mRS ≤ 2) at 90 days. The discrimination power is significantly higher when ASPECTS-NWU is combined with the clinical model (age and NIHSS) and is further improved when vessel recanalization is added.
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FIG 4.
A patient with acute ischemic stroke due to occlusion of the M1 segment of the left MCA. This patient had an NIHSS score of 15 at admission and a low ASPECTS of 5. The mean value of ASPECTS-NWU at admission CT was 8.2%. Complete revascularization (mTICI grade 3) was achieved after mechanical thrombectomy. This patient had a favorable outcome, with an mRS score of 1 at 90 days. C indicates caudate nucleus; IC, internal capsule; L, lenticular nucleus; I, insula.

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Table 1:

Independent clinical and imaging predictors for a 90-day favorable outcome

Variables	Univariable Analyses		Multivariable Analyses
Variables	OR (95% CI)	P Value	OR (95% CI)	P Value
Age	0.97 (0.95–0.99)	<.001	0.96 (0.94–0.99)	.007
Male sex	1.62 (1.01–2.58)	.043	1.56 (0.84–2.91)	.159
NIHSS_admission	0.89 (0.86–0.92)	<.001	0.91 (0.87–0.96)	<.001
ASPECTS	1.52 (1.33–1.73)	<.001	1.18 (0.98–1.43)	.086
ASPECTS-NWU	0.75 (0.68–0.82)	<.001	0.79 (0.70–0.90)	<.001
Vessel recanalization	3.44 (2.10–5.63)	<.001	7.78 (3.96–15.29)	<.001

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Table 2:

Predication models for a 90-day favorable outcome^{^a}

Prediction Models	AUC	Sensitivity	Specificity
Age + NIHSS	0.727 (0.670–0.784)	45.5 (37.5–53.7)	90.7 (84.5–94.9)
NWU	0.737 (0.681–0.793)	57.7 (49.5–65.6)	78.4 (70.6–84.9)
Age + NIHSS + NWU	0.794 (0.744–0.845)	76.3 (68.8–82.7)	71.9 (63.7–79.2)
Age + NIHSS + NWU + Recanalization	0.856 (0.814–0.899)	76.3 (68.8–82.7)	81.3 (73.8–87.4)