ObjectivesThis study aimed to evaluate the factors associated with decreasing diffusion-weighted imaging (DWI) positive areas in patients with large early ischemic changes after mechanical thrombectomy (MT).Materials and MethodsThis retrospective single-center clinical study was conducted between January 2013 and December 2022. We included consecutive patients who underwent MT for acute large-vessel occlusion of the anterior circulation with low pretreatment DWI-Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) (0–5), effective recanalization [thrombolysis in cerebral infarction (TICI) 2b or TICI3], and magnetic resonance imaging (MRI) acquired before and after MT. We measured the DWI-positive area volume before and after MT. The primary endpoint was the after/before-MT DWI-positive area–volume ratio.ResultsIn total, 28 patients were included in this study. Eight patients (29%) had an after/before-MT DWI-positive area–volume ratio of <1. The median mean apparent diffusion coefficient (ADC) levels of the DWI-positive areas in the groups with a ratio of <1 or >1 were 717 × 10⁶ mm2/s and 637 × 106 mm2/s, respectively ( p = 0.011). Multivariate logistic regression analysis showed that ADC level (OR, 1.020 [95% confidence intervals (CIs), 1.001–1.040]; p = 0.040) was an independent predictor of a decreased DWI-positive area after MT. There was a negative correlation between the mean ADC level and the after/before-MT DWI-positive area–volume ratio ( p < 0.001, | ρ| = 0.650), and the mean pretreatment ADC cutoff level was 649 × 106 mm2/s (area under the curve (AUC) = 0.806) for predicting a volume ratio of <1.ConclusionsThe mean ADC level before-MT correlated with the after/before-MT DWI-positive area–volume ratio. A mean pretreatment ADC cutoff level of 649 × 106 mm2/s predicted a decreased DWI-positive area after MT.

中文翻译：

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早期大面积缺血性改变患者机械取栓后弥散加权成像阳性面积减少的相关因素

目的本研究旨在评估机械取栓（MT）后早期大面积缺血性改变患者弥散加权成像（DWI）阳性面积减少的相关因素。材料和方法这项回顾性单中心临床研究于2013年1月至2022年12月进行。我们纳入了因前循环急性大血管闭塞而接受 MT 的连续患者，治疗前 DWI-阿尔伯塔卒中计划早期计算机断层扫描评分 (ASPECTS) (ASPECTS) (0-5)、有效再通[脑梗塞溶栓 (TICI) 2b或 TICI3]，以及 MT 前后采集的磁共振成像 (MRI)。我们测量了 MT 前后的 DWI 阳性面积体积。主要终点是 MT 后/前 DWI 阳性面积-体积比。结果 本研究总共纳入 28 名患者。 8 名患者 (29%) MT 后/前 DWI 阳性面积体积比 <1。比例<1或>1的组中DWI阳性区域的中位表观扩散系数（ADC）水平为717×10⁶ mm2/s 和 637 × 106毫米2/s（p = 0.011）。多变量逻辑回归分析显示，ADC 水平（OR，1.020 [95% 置信区间 (CI)，1.001–1.040]；p = 0.040）是 MT 后 DWI 阳性面积减少的独立预测因子。平均 ADC 水平与 MT 后/前 DWI 阳性面积体积比呈负相关（p < 0.001，| ρ| = 0.650），治疗前平均 ADC 截止水平为 649 × 106毫米2/s（曲线下面积 (AUC) = 0.806）用于预测体积比 <1。结论 MT 前的平均 ADC 水平与 MT 后/前 DWI 阳性面积-体积比相关。平均预处理 ADC 截止水平为 649 × 106毫米2/s 预测 MT 后 DWI 阳性面积减少。