The Association between Diffusion MRI‐Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke

• Published in: Journal of neuroimaging Vol. 27; no. 4; pp. 388 - 391
• Main Authors: Yaghi, Shadi, Herber, Charlotte, Boehme, Amelia K., Andrews, Howard, Willey, Joshua Z., Rostanski, Sara K., Siket, Matthew, Jayaraman, Mahesh V., McTaggart, Ryan A., Furie, Karen L., Marshall, Randolph S., Lazar, Ronald M., Boden‐Albala, Bernadette
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2017
• Subjects: Aged; Brain - diagnostic imaging; Brain Ischemia - diagnostic imaging; Correlation analysis; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Image processing; Image Processing, Computer-Assisted; infarct volume; ischemic stroke; Magnetic resonance imaging; Male; Middle Aged; Minor stroke; Neglect syndromes; Neuroimaging; NIHSS; NMR; Nuclear magnetic resonance; outcome; Patients; Severity of Illness Index; Stroke; Stroke - diagnostic imaging; Stroke volume; Visual field; Visual fields; Warning; NIHSS; Minor stroke; infarct volume; ischemic stroke; outcome; neuroimaging
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12423

ABSTRACT
BACKGROUND
Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) and stroke volume on diffusion weighted imaging (DWI); data are more limited in patients with minor stroke. We sought to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS component scores in patients with minor stroke.
METHODS
We included all patients with minor stroke (NIHSS 0–5) enrolled in the Stroke Warning Information and Faster Treatment study. We calculated lesion(s) volume (cm3) on the DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). We used nonparametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components).
RESULTS
We identified 894 patients with a discharge diagnosis of minor stroke; 709 underwent magnetic resonance imaging and 510 were DWI positive. There was a graded relationship between the NIHSS score and median DWI lesion volume in cm3: (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, and NIHSS 5: 23.6, P < .01). The median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5, P = .025), language disorder (34.6 vs. 11.9, P < .001), and visual field impairment (185.6 vs. 11.6, P < .001). Other components of the NIHSS were not associated with lesion volume.
CONCLUSION
In patients with minor stroke, the nature of deficit when used with the NIHSS score can improve prediction of infarct volume. This may have clinical and therapeutic implications.