Original Articles

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

  1. Gregory W. Albers MD1,*,
  2. Vincent N. Thijs MD, PhD3,
  3. Lawrence Wechsler MD4,
  4. Stephanie Kemp BS1,
  5. Gottfried Schlaug MD, PhD5,
  6. Elaine Skalabrin MD6,
  7. Roland Bammer PhD2,
  8. Wataru Kakuda MD1,
  9. Maarten G. Lansberg MD, PhD1,
  10. Ashfaq Shuaib MD7,
  11. William Coplin MD7,
  12. Scott Hamilton PhD1,
  13. Michael Moseley PhD2,
  14. Michael P. Marks MD2

Article first published online: 25 OCT 2006

DOI: 10.1002/ana.20976

Issue

Annals of Neurology

Annals of Neurology

Volume 60, Issue 5, pages 508–517, November 2006

Additional Information

How to Cite

Albers, G. W., Thijs, V. N., Wechsler, L., Kemp, S., Schlaug, G., Skalabrin, E., Bammer, R., Kakuda, W., Lansberg, M. G., Shuaib, A., Coplin, W., Hamilton, S., Moseley, M. and Marks, M. P. (2006), Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol., 60: 508–517. doi: 10.1002/ana.20976

Author Information

  1. 1

    Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA

  2. 2

    Department of Radiology and the Stanford Stroke Center, Stanford University Medical Center, Stanford CA

  3. 3

    Department of Neurology, University Hospitals Leuven, Leuven, Belgium

  4. 4

    UPMC Stroke Institute and Department of Neurology, University of Pittsburgh, PA

  5. 5

    Division of Cerebrovascular Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA

  6. 6

    Department of Neurology, University of Utah, Salt Lake City, UT

  7. 7

    Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada (AS)

*Department of Neurology and Neurological Sciences, Stanford University Medical Center, 701 Welch Road, Suite 325, Palo Alto, CA 94304

Publication History

  1. Issue published online: 21 NOV 2006
  2. Article first published online: 25 OCT 2006
  3. Manuscript Revised: 22 AUG 2006
  4. Manuscript Accepted: 22 AUG 2006
  5. Manuscript Received: 15 JUL 2006

Funded by

  • NIH (National Institute on Neurological Disorders and Stroke). Grant Numbers: RO1 NS39325, K24 NS044848

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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

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