Presence of deep white matter lesions on diffusion-weighted imaging is a negative predictor of early dramatic improvement after intravenous tissue plasminogen activator thrombolysis.

Background: The impact of deep white matter lesions observed at the corona radiata on diffusion-weighted MRI (DWI-W lesions) on the clinical recovery of patients after tissue plasminogen activator (tPA) therapy is unclear. Our goal was to elucidate whether DWI findings before tPA could predict clinical recovery.
Methods: A total of 83 consecutive patients with hyperacute anterior circulation ischemic stroke were enrolled. All patients underwent MRI within 3 h and received intravenous tPA. The relationships among the Alberta Stroke Program Early CT Score (ASPECTS) on DWI (DWI-ASPECTS), DWI-W lesions, early dramatic improvement (> or =10-point reduction in the total National Institutes of Health Stroke Scale, NIHSS, score or a total NIHSS score of 0-2 after 24 h), early improvement (> or =4-point reduction in the total NIHSS score after 24 h) and worsening (> or =4-point increase in the total NIHSS score after 24 h) were assessed.
Results: The median of the baseline DWI-ASPECTS value was 9 (range: 5-10), and DWI-W lesions were found in 36 patients (43%). Patients with early dramatic improvement had a shorter time from onset to tPA (116.1 +/- 34.9 vs. 133.2 +/- 33.1 min; p = 0.0281) and higher DWI-ASPECTS (medians: 9 vs. 9; p = 0.0568). DWI-W lesions were seen less frequently in patients with than without early dramatic improvement (26 vs. 54%; p = 0.0213). Multivariate logistic regression analysis demonstrated that absence of DWI-W lesions (OR: 1.80; 95% CI: 1.08-3.13; p = 0.0279), higher ASPECTS (OR: 1.56; 95% CI: 1.06-2.46; p = 0.0346) and shorter time from onset to tPA (OR: 0.98; 95% CI: 0.97-0.99; p = 0.0429) were independent predictors of early dramatic improvement.
Conclusions: DWI-ASPECTS and DWI-W lesions appear to be useful tools for predicting early dramatic improvement.
(Copyright 2010 S. Karger AG, Basel.)