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

Shadi Yaghi, Charlotte Herber, Amelia K. Boehme, Howard Andrews, Joshua Z. Willey, Sara K. Rostanski, Matthew Siket, Mahesh V. Jayaraman, Ryan A. Mctaggart, Karen L. Furie, Randolph S. Marshall, Ronald M. Lazar, Bernadette Boden-Albala

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Neuroimaging
DOIs
StateAccepted/In press - 2017

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Diffusion Magnetic Resonance Imaging
National Institutes of Health (U.S.)
Stroke
Language Disorders

Keywords

  • Infarct volume
  • Ischemic stroke
  • Minor stroke
  • Neuroimaging
  • NIHSS
  • Outcome

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

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

In: Journal of Neuroimaging, 2017.

Research output: Contribution to journalArticle

Yaghi, S, Herber, C, Boehme, AK, Andrews, H, Willey, JZ, Rostanski, SK, Siket, M, Jayaraman, MV, Mctaggart, RA, Furie, KL, Marshall, RS, Lazar, RM & Boden-Albala, B 2017, 'The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke', Journal of Neuroimaging. https://doi.org/10.1111/jon.12423
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. / The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke. In: Journal of Neuroimaging. 2017.
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AU - Yaghi, Shadi

AU - Herber, Charlotte

AU - Boehme, Amelia K.

AU - Andrews, Howard

AU - Willey, Joshua Z.

AU - Rostanski, Sara K.

AU - Siket, Matthew

AU - Jayaraman, Mahesh V.

AU - Mctaggart, Ryan A.

AU - Furie, Karen L.

AU - Marshall, Randolph S.

AU - Lazar, Ronald M.

AU - Boden-Albala, Bernadette

PY - 2017

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N2 - 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.

AB - 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.

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KW - Ischemic stroke

KW - Minor stroke

KW - Neuroimaging

KW - NIHSS

KW - Outcome

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