Serial Changes in Ischemic Lesion Volume and Neurological Recovery After T-PA Therapy

Background And Purpose: The present study investigated the relationship between serial changes in ischemic lesion volume (ILV) and neurological recovery after t-PA therapy.

Methods: A total of 110 consecutive patients with ICA and MCA occlusion on MRA treated with t-PA within 3 h of onset were prospectively studied. MRI including MRA, DWI, and FLAIR, was performed before, 1 h, 24 h, and 7 days after t-PA infusion to measure serial changes in ILV.

Results: The mean (SD) values of ILV at baseline, 1 h, 24 h, and 7 days after t-PA infusion were 30.2 (61.0), 48.1 (76.3), 98.3 (125.3), and 125.9 (149.8) cm(3), respectively. Recovery at 7 days was remarkable in 46 patients and good in 21 patients. Change in NIHSS score (baseline NIHSS minus NIHSS at 7 days) correlated with ΔILV (ILV at 7 days minus baseline ILV) (r=0.611, P<0.0001). Sensitivity and specificity curve analysis demonstrated that a cutoff value for ΔILV of 40 cm(3) (sensitivity, 80.0%; specificity, 79.3%) indicated remarkable recovery, and that 80 cm(3) (78.8% and 76.3%) indicated good recovery.

Conclusion: The thresholds of ΔILV enlargement for remarkable and good recovery after t-PA therapy were 40 and 80 cm(3), respectively.