Diffusion-weighted imaging as predictor of acute ischemic stroke etiology

We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]).

Results:

There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies.

Conclusions:

A relationship exists between DWI and stroke subtype.

Keywords:
Stroke; Ischemic Stroke; Diffusion Magnetic Resonance Imaging; Diagnosis

DWI pattern/TOAST subtypes		LAA (n=173)	Cardioembolic (n=282)	Cryptogenic (n=289)	Lacunar (n=153)	Other causes (n=122)	Total (n=1,019)
Negative DWI		8	30	47	46	11	142
Single lesion							483
	Corticosub-cortical	20	84	61	0	18	183
	Cortical	5	18	26	0	5	54
	Subcortical 20 mm and over	7	24	27	1	11	70
	Subcortical less 20 mm	26	16	14	105	15	176
SLVT							198
	SLVT Small (<15 mm)	61	22	33	0	15	131
	SLVT Confluent lesion (≥15 mm)	16	25	20	0	6	67
Multiple lesions							196
	MAC	4	10	5	0	4	23
	MPC	18	9	17	0	13	57
	MBAC	3	12	13	1	7	36
	MAP	5	32	26	0	17	80

DWI pattern	Etiology	OR	p-value	95%CI
Negative	LAA	1.00
	LC	8.87	<0.001	4.03–19.52
	Undet	4.01	<0.001	1.84–8.7
	CE	2.46	0.029	1.1–5.49
	Other	2.04	0.13	0.80–5.24
Cortico-subcortical	LAA	1.00
	CE	3.24	<0.001	1.9–5.52
	Undet	2.1	0.01	1.18–3.52
	Other	1.32	0.42	0.66–2.62
	LC	Empty
Cortical	LAA	1.00
	Undet	3.32	0.016	1.25–8.81
	CE	2.29	0.18	0.83–6.28
	Other	1.43	0.57	0.4–5.07
	LC	Empty
Subcortical >20mm	LAA	1.00
	Undet	2.44	0.04	1.04–7.73
	Other	2.35	0.08	0.88–6.24
	CE	2.2	0.07	0.92–5.23
	LC	0.15	0.08	0.01–1.28
Subcortical <20 mm	Undet	1.00	1.00
	LC	42.9	<0.001	22.7–81.1
	LAA	3.47	<0.001	1.76–6.85
	Other	2.75	0.009	1.28–5.89
	CE	1.18	0.65	0.56–2.46
SSCL	Undet	1.00
	LAA	4.22	<0.001	2.61–6.8
	Other	1.08	0.145	0.56–2.08
	CE	0.65	0.14	0.37–1.15
	LC	Empty
SLVT	Other	1.00
	LAA	1.97	0.18	0.74–5.18
	CE	1.88	0.17	0.75–4.7
	Undet	1.57	0.67	0.56–3.67
	LC	Empty
MAC	Undet	1.00
	CE	2.08	0.18	0.7–6.18
	Other	1.92	0.33	0.5–7.29
	LAA	1.34	0.66	0.35–5.07
	LC	Empty
MPC	CE	1.00
	Other	3.61	0.004	1.5–8.7
	Undet	3.61	0.004	1.5–8.7
	LAA	3.52	0.003	1.54–8.03
	LC	Empty
MBAC	LC	1.00
	Other	9.25	<0.001	1.12–76.2
	Undet	7.15	0.059	0.92–55.2
	CE	6.75	0.068	0.86–52.4
	LC	2.68	0.39	0.27–26
MAP	LAA	1.00
	Other	5.54	0.001	1.94–15.1
	CE	4.30	0.003	1.64–11.2
	Undet	3.32	0.016	1.25–8.8
	LC	Empty

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[1] Correspondence: Alejandro Michel Brunser; Email: abrunser2017@gmail.com.