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Diffusion MRI Reversibility in Ischemic Stroke Following Thrombolysis: A Meta‐Analysis
Author(s) -
Lakomkin Nikita,
Pan Jonathan,
Stein Laura,
Malkani Brijesh,
Dhamoon Mandip,
Mocco J
Publication year - 2020
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12703
Subject(s) - medicine , thrombolysis , stroke (engine) , context (archaeology) , magnetic resonance imaging , meta analysis , diffusion mri , inclusion and exclusion criteria , systematic review , clinical trial , infarction , medline , radiology , pathology , myocardial infarction , alternative medicine , mechanical engineering , paleontology , political science , law , engineering , biology
BACKGROUND AND PURPOSE Diffusion‐weighted magnetic resonance imaging (DWI) detects early infarction in acute stroke. With the substantial progress in stroke therapies, the frequency of posttreatment DWI reversibility in modern stroke cohorts is currently unknown. The purpose of this study was to perform a systematic literature review examining the relationship between characteristics of patients with ischemic stroke and DWI reversibility following treatment with lytic therapy. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, yielding a total of 422 unique articles. Studies that were nonclinical or did not report data pertaining to DWI reversibility in the context of an acute stroke series were excluded. Characteristics regarding presentation, diagnosis, intervention, and the timing of DWI reversibility were collected for each study. RESULTS After full‐text review, 10 studies were identified as meeting inclusion criteria. The number of patients with DWI reversal ranged from .9% to 50%, whereas the extent of reversal ranged from 1.8% to 72.7%. Studies reporting on younger patients describe greater rates of reversibility following stroke treatment. CONCLUSIONS These data suggest that early DWI signal may not represent the definitive DWI burden in recanalized populations. However, substantial heterogeneity exists regarding the rate of DWI reversal following recanalization. Additional studies are needed to elucidate the relationship among time to treatment, early reversal rates, and clinical outcomes. Physicians should use caution when basing clinical decisions on DWI lesion volumes, as these likely change to some degree with recanalization.