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• Clinical Article •
The treatment effect of modified DWI-FLAIR mismatch guided thrombosis in wake-up ischemic stroke
GUO Qun  LI Lu  WU Han  PENG Mingyang  YIN Xindao  ZHAO Xiaojing 

Cite this article as: Guo Q, Li L, Wu H, et al. The treatment effect of modified DWI-FLAIR mismatch guided thrombosis in wake-up ischemic stroke. Chin J Magn Reson Imaging, 2020, 11(10): 853-857. DOI:10.12015/issn.1674-8034.2020.10.004.


[Abstract] Objective: To investigate the safety, efficacy and outcome influencing factors of thrombosis in wake-up ischemic stroke (WUIS) using a modified diffusion-weighted imaging (DWI)-fluid-attenuated inversion-recovery (FLAIR) mismatch allowing for partial FLAIR positivity.Materials and Methods: A total of one hundred WUIS patients from January 2016 to January 2020 were collected retrospectively. All patients underwent emergency craniocerebral MRI examination before treatment. Patients with modified DWI-FLAIR mismatch were treated with thrombosis therapy. Multiple logistic regression analysis was performed to evaluate the influencing factors of WUIS patients.Results: The rate of neurological improvement (NIHSS≥4 score) (54.69% vs 30.56%; χ2=5.402, P=0.023) and favorable outcome (mRS score) (39.06% vs 19.44%; χ2=4.075, P=0.048) in modified DWI-FLAIR mismatch group (n=64) were significantly higher than those in DWI-FLAIR match group (n=36), while there were no significant difference in neurological improvement (NIHSS≥4 score) and favorable outcome (mRS score) between FLAIR negative group and partial FLAIR positivity group in subgroup of modified DWI-FLAIR mismatch (P>0.05). Multiple logistic regression analysis showed that intravenous thrombolysis (OR=1.266, 95% CI: 1.052—1.443, P=0.004), modified DWI-FLAIR mismatch (OR=1.076, 95% CI: 0.527—1.884, P=0.013), glycosylated hemoglobin on admission (OR=1.190, 95% CI: 0.459—4.925, P=0.038), neurological improvement (NIHSS≥4 score) (OR=1.120, 95% CI: 0.570—2.210, P=0.021) were independently associated with outcome at 3 months in WUIS patients.Conclusions: It is safe and effective to use the modified DWI-FLAIR mismatch allowing for partial FLAIR positivity to select the patients with wake-up ischemic stroke for intravenous thrombolysis.
[Keywords] ischemic stroke；diffusion-weighted imaging；fluid-attenuated inversion-recovery；intravenous thrombolysis；magnetic resonance imaging

GUO Qun Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

LI Lu Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China

WU Han Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

PENG Mingyang Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

YIN Xindao Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

ZHAO Xiaojing* Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

*Correspondence to: Zhao XJ, E-mail: zhaoxiaojing96@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS  This work was part of Jiangsu Science and Technology Development Project No. BE2017614
Received  2020-05-09
Accepted  2020-06-23
DOI: 10.12015/issn.1674-8034.2020.10.004
Cite this article as: Guo Q, Li L, Wu H, et al. The treatment effect of modified DWI-FLAIR mismatch guided thrombosis in wake-up ischemic stroke. Chin J Magn Reson Imaging, 2020, 11(10): 853-857. DOI:10.12015/issn.1674-8034.2020.10.004.

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