Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study

TLDR

The study aimed to determine whether baseline MRI profiles could identify stroke patients who would benefit from early reperfusion within 3–6 hours of symptom onset. A prospective, multicenter study of 74 consecutive stroke patients performed MRI scans immediately before and 3–6 hours after intravenous tPA, using baseline MRI profiles to categorize patients and compare clinical responses based on early reperfusion achievement. Early reperfusion significantly increased the odds of a favorable clinical response in patients with perfusion/diffusion mismatch (OR 5.4) and even more so in those with the Target Mismatch profile (OR 8.7), while patients with No Mismatch did not benefit and those with a Malignant profile faced fatal intracranial hemorrhage. Published in Annals of Neurology, 2006.

Abstract

Abstract Objective To determine whether prespecified baseline magnetic resonance imaging (MRI) profiles can identify stroke patients who have a robust clinical response after early reperfusion when treated 3 to 6 hours after symptom onset. Methods We conducted a prospective, multicenter study of 74 consecutive stroke patients admitted to academic stroke centers in North America and Europe. An MRI scan was obtained immediately before and 3 to 6 hours after treatment with intravenous tissue plasminogen activator 3 to 6 hours after symptom onset. Baseline MRI profiles were used to categorize patients into subgroups, and clinical responses were compared based on whether early reperfusion was achieved. Results Early reperfusion was associated with significantly increased odds of achieving a favorable clinical response in patients with a perfusion/diffusion mismatch (odds ratio, 5.4; p = 0.039) and an even more favorable response in patients with the Target Mismatch profile (odds ratio, 8.7; p = 0.011). Patients with the No Mismatch profile did not appear to benefit from early reperfusion. Early reperfusion was associated with fatal intracranial hemorrhage in patients with the Malignant profile. Interpretation For stroke patients treated 3 to 6 hours after onset, baseline MRI findings can identify subgroups that are likely to benefit from reperfusion therapies and can potentially identify subgroups that are unlikely to benefit or may be harmed. Ann Neurol 2006