Apparent Diffusion Coefficient Composition and Tissue Heterogeneity as Predictors of Functional Outcomes After Endovascular Thrombectomy in Patients With Large Ischemic Core
- 1Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.K., B.-S.S., K.-H.C., J.-T.K., M.-S.P.).
- 2Artificial Intelligence Research Center, JLK Inc, Seoul, Korea (W.-S.R.).
Abstract
Background
Recent trials established endovascular thrombectomy efficacy in large ischemic cores, yet outcomes remain heterogeneous despite similar infarct volumes, suggesting that current volumetric assessments may not fully capture tissue viability. We examined whether tissue composition quantified by apparent diffusion coefficient (ADC) distribution and tissue heterogeneity within baseline diffusion-weighted imaging lesions are associated with functional outcomes in large-core patients after successful endovascular thrombectomy.Methods
We retrospectively analyzed patients with large vessel occlusion with large ischemic cores (diffusion-weighted imaging candidate volume ≥50 mL) achieving successful reperfusion after endovascular thrombectomy. We quantified ADC tissue composition as proportions within 3 ADC ranges relative to total diffusion-weighted imaging lesion volume: low (<540), mid (540-700), and high (>700 × 10⁻⁶ mm²/s). Separately, tissue heterogeneity was assessed using Shannon entropy, a metric quantifying ADC distribution heterogeneity. The primary outcome was 3-month good functional outcome (modified Rankin Scale score of 0-3), analyzed via adjusted logistic regression.Results
Among 126 patients (age, 70.8±12.4 years; 60.3% men; diffusion-weighted imaging candidate volume, 93.7±41.2 mL), 39.7% achieved a good functional outcome. Both tissue heterogeneity (adjusted odds ratio, 1.45 per 0.1-unit increase, 1.09-1.93, P=0.011, area under the curve, 0.671) and mid-ADC fraction (adjusted odds ratio, 1.78 per 5% increase, 1.20-2.63, P=0.004, area under the curve, 0.688) were associated with good functional outcomes. Neither low-ADC nor high-ADC fractions showed significant associations with functional outcomes.Conclusions
Higher mid-ADC (540-700 × 10⁻⁶ mm²/s) fraction and greater tissue heterogeneity predicted favorable outcomes in patients with large ischemic core, indicating that tissue composition within the ischemic core, beyond its volume, is associated with functional outcome after reperfusion. Among large-core patients who achieved successful reperfusion, ADC-based tissue characterization may help predict functional outcome.
Related
- Apparent Diffusion Coefficient Fraction Predicts Endovascular Thrombectomy Benefit in Large Ischemic Core
- Endovascular thrombectomy activity as a candidate marker of organised acute stroke-service capacity: a global burden of disease-based European panel study
- Endovascular thrombectomy for mild vertebrobasilar artery occlusion: a hierarchical win-ratio analysis
- Technical considerations in endovascular thrombectomy for distal vessel occlusions
- Endovascular mechanical thrombectomy for the treatment of extensive postpartum cerebral venous sinus thrombosis: a case report
BibTeX
@article{kim2026apparent,
title = {{Apparent Diffusion Coefficient Composition and Tissue Heterogeneity as Predictors of Functional Outcomes After Endovascular Thrombectomy in Patients With Large Ischemic Core}},
author = {Hyunsoo Kim and Beom-Seok Seo and Wi-Sun Ryu and Kang-Ho Choi and Joon-Tae Kim and Man-Seok Park},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1161/svin.126.002570},
url = {https://europepmc.org/article/PMC/PMC13727206},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Apparent Diffusion Coefficient Composition and Tissue Heterogeneity as Predictors of Functional Outcomes After Endovascular Thrombectomy in Patients With Large Ischemic Core
AU - Hyunsoo Kim
AU - Beom-Seok Seo
AU - Wi-Sun Ryu
AU - Kang-Ho Choi
AU - Joon-Tae Kim
AU - Man-Seok Park
PY - 2026
DA - 2026/10/15
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.126.002570
UR - https://europepmc.org/article/PMC/PMC13727206
AB - Background Recent trials established endovascular thrombectomy efficacy in large ischemic cores, yet outcomes remain heterogeneous despite similar infarct volumes, suggesting that current volumetric assessments may not fully capture tissue viability. We examined whether tissue composition quantified by apparent diffusion coefficient (ADC) distribution and tissue heterogeneity within baseline diffusion-weighted imaging lesions are associated with functional outcomes in large-core patients after successful endovascular thrombectomy.Methods We retrospectively analyzed patients with large vessel occlusion with large ischemic cores (diffusion-weighted imaging candidate volume ≥50 mL) achieving successful reperfusion after endovascular thrombectomy. We quantified ADC tissue composition as proportions within 3 ADC ranges relative to total diffusion-weighted imaging lesion volume: low (<540), mid (540-700), and high (>700 × 10⁻⁶ mm²/s). Separately, tissue heterogeneity was assessed using Shannon entropy, a metric quantifying ADC distribution heterogeneity. The primary outcome was 3-month good functional outcome (modified Rankin Scale score of 0-3), analyzed via adjusted logistic regression.Results Among 126 patients (age, 70.8±12.4 years; 60.3% men; diffusion-weighted imaging candidate volume, 93.7±41.2 mL), 39.7% achieved a good functional outcome. Both tissue heterogeneity (adjusted odds ratio, 1.45 per 0.1-unit increase, 1.09-1.93, P=0.011, area under the curve, 0.671) and mid-ADC fraction (adjusted odds ratio, 1.78 per 5% increase, 1.20-2.63, P=0.004, area under the curve, 0.688) were associated with good functional outcomes. Neither low-ADC nor high-ADC fractions showed significant associations with functional outcomes.Conclusions Higher mid-ADC (540-700 × 10⁻⁶ mm²/s) fraction and greater tissue heterogeneity predicted favorable outcomes in patients with large ischemic core, indicating that tissue composition within the ischemic core, beyond its volume, is associated with functional outcome after reperfusion. Among large-core patients who achieved successful reperfusion, ADC-based tissue characterization may help predict functional outcome.
SN - 2694-5746
ER -