Background: This study investigates the prognostic value of the apparent diffusion coefficient (ADC) in MRI for patients with acute posterior circulation stroke (PCS) undergoing endovascular therapy (EVT).
Methods: A retrospective analysis was conducted on patients with acute PCS from January 2017 to December 2021, confirmed by Diffusion Weighted Imaging (DWI)-ADC within 24 hours of onset. Patients were categorized based on their 3-month mRS score post-EVT. Data on NIHSS at admission, ADC value, and 3-month mRS were collected. Multivariable logistic regression analyzed the impact of various factors on ADC values. The receiver operating characteristic curve assessed predictive indices.
Results: Among 94 patients, 47 had a good prognosis, and 47 had a poor prognosis. Univariate analysis revealed that factors significantly associated with a good prognosis included lower NIHSS at admission, higher ADC values, smaller infarct areas, unilateral infarction, basilar artery occlusion, lower PMT scores, intravenous thrombolysis, intra-arterial thrombolysis, and fewer perioperative complications (p < 0.05). Multivariable logistic regression identified high ADC values (p=0.002) and unilateral infarction (p=0.017) as independent predictive factors for prognosis. An ADC value > 549×10- 6 mm2/s was associated with a higher rate of good prognosis. Combining ADC values with unilateral infarction resulted in the highest AUC and Youden index of 0.766, with sensitivity and specificity of 89.36% and 87.23%, respectively (p<0.05).
Conclusion: High ADC values and unilateral infarction are independent predictive factors for the prognosis of PCS patients after EVT. Combining these factors provides the highest predictive accuracy, aiding in clinical decision-making for PCS treatment.
Keywords: apparent diffusion coefficient; diffusion-weighted imaging; endovascular treatment; posterior circulation stroke; prognostic value.
Copyright © 2024. Published by Elsevier Inc.