Apparent Diffusion Coefficient Fraction Predicts Endovascular Thrombectomy Benefit in Large Ischemic Core
- 1Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Abstract
Background
Endovascular thrombectomy (EVT) is recommended for large ischemic core stroke, but which patients within this population derive meaningful benefit remains uncertain. We investigated whether the fraction of apparent diffusion coefficient (ADC)-defined infarct volume within the ischemic lesion predicts EVT outcomes in large ischemic core stroke.Methods
This retrospective study included patients with diffusion-weighted imaging volume ≥50 cm³ and large vessel occlusion within 24-hour of onset (2016-2024; EVT:130, no-EVT:192). The ADC fraction was defined as the volume of ADC <540 × 10⁻⁶ mm²/s divided by initial diffusion-weighted imaging volume. Overlap weighting (OW) with doubly robust estimation corrected for indication bias. Primary outcomes were modified Rankin Scale shift and favorable outcome (modified Rankin Scale score 0-3) at 3-month. The relationship between ADC fraction and EVT treatment effect was examined using overlap-weighted restricted cubic spline interaction analysis, and treatment effects were subsequently quantified above and below the crossover point.Results
A total of 322 patients were included (age, 73.8 years, 51.9% men). Before OW, patients with EVT were younger with lower National Institutes of Health Stroke Scale score and smaller diffusion-weighted imaging volumes (EVT: 93.8 cm³, no-EVT: 129.9 cm³). After OW, all covariates were well-balanced. The doubly robust-OW analysis demonstrated attenuation of EVT effect on ordinal modified Rankin Scale score shift (odds ratio, 1.37 [95% CI, 0.85-2.21]) and favorable outcome (odds ratio, 1.73 [95% CI, 0.91-3.28]). ADC fraction significantly modified the EVT treatment effect (P interaction=0.009), with a crossover at 48%, identified as a data-derived exploratory threshold. Below this threshold, EVT was associated with a favorable ordinal modified Rankin Scale score shift (odds ratio, 1.85 [95% CI, 1.05-3.26]), whereas above it the direction of the association was reversed (odds ratio, 0.42 [95% CI, 0.19-0.95]).Conclusions
In large ischemic core stroke, the association between EVT and functional outcome varied according to infarct tissue composition. The ADC fraction distinguished patients in whom EVT was associated with more favorable outcomes from those in whom this association was not observed, supporting its potential as an imaging biomarker to inform individualized treatment decisions.
Related
- Apparent Diffusion Coefficient Composition and Tissue Heterogeneity as Predictors of Functional Outcomes After Endovascular Thrombectomy in Patients With Large Ischemic Core
- Apparent diffusion coefficient values on MRI as biomarkers for pre operative prediction of prognostic factors in endometrial cancer
- Combined apparent diffusion coefficient histogram and MRI-based fractal analysis for predicting lymph node metastasis in esophageal squamous cell carcinoma
- Diagnostic value of a multiparametric magnetic resonance imaging-based nomogram incorporating apparent diffusion coefficient in preoperative differentiation of phyllodes tumors from breast cancer: a retrospective study
- Apparent diffusion coefficient histogram parameters of the whole tumor based on whole-body magnetic resonance imaging can better characterize the tumor burden of multiple myeloma and predict survival prognosis
BibTeX
@article{kim2026apparent,
title = {{Apparent Diffusion Coefficient Fraction Predicts Endovascular Thrombectomy Benefit in Large Ischemic Core}},
author = {Hyunsoo Kim and Beom-Seok Seo and Kang-Ho Choi and Man-Seok Park and Joon-Tae Kim},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = sep,
doi = {10.1161/svin.126.002588},
url = {https://europepmc.org/article/PMC/PMC13727201},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Apparent Diffusion Coefficient Fraction Predicts Endovascular Thrombectomy Benefit in Large Ischemic Core
AU - Hyunsoo Kim
AU - Beom-Seok Seo
AU - Kang-Ho Choi
AU - Man-Seok Park
AU - Joon-Tae Kim
PY - 2026
DA - 2026/09/24
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.126.002588
UR - https://europepmc.org/article/PMC/PMC13727201
AB - Background Endovascular thrombectomy (EVT) is recommended for large ischemic core stroke, but which patients within this population derive meaningful benefit remains uncertain. We investigated whether the fraction of apparent diffusion coefficient (ADC)-defined infarct volume within the ischemic lesion predicts EVT outcomes in large ischemic core stroke.Methods This retrospective study included patients with diffusion-weighted imaging volume ≥50 cm³ and large vessel occlusion within 24-hour of onset (2016-2024; EVT:130, no-EVT:192). The ADC fraction was defined as the volume of ADC <540 × 10⁻⁶ mm²/s divided by initial diffusion-weighted imaging volume. Overlap weighting (OW) with doubly robust estimation corrected for indication bias. Primary outcomes were modified Rankin Scale shift and favorable outcome (modified Rankin Scale score 0-3) at 3-month. The relationship between ADC fraction and EVT treatment effect was examined using overlap-weighted restricted cubic spline interaction analysis, and treatment effects were subsequently quantified above and below the crossover point.Results A total of 322 patients were included (age, 73.8 years, 51.9% men). Before OW, patients with EVT were younger with lower National Institutes of Health Stroke Scale score and smaller diffusion-weighted imaging volumes (EVT: 93.8 cm³, no-EVT: 129.9 cm³). After OW, all covariates were well-balanced. The doubly robust-OW analysis demonstrated attenuation of EVT effect on ordinal modified Rankin Scale score shift (odds ratio, 1.37 [95% CI, 0.85-2.21]) and favorable outcome (odds ratio, 1.73 [95% CI, 0.91-3.28]). ADC fraction significantly modified the EVT treatment effect (P interaction=0.009), with a crossover at 48%, identified as a data-derived exploratory threshold. Below this threshold, EVT was associated with a favorable ordinal modified Rankin Scale score shift (odds ratio, 1.85 [95% CI, 1.05-3.26]), whereas above it the direction of the association was reversed (odds ratio, 0.42 [95% CI, 0.19-0.95]).Conclusions In large ischemic core stroke, the association between EVT and functional outcome varied according to infarct tissue composition. The ADC fraction distinguished patients in whom EVT was associated with more favorable outcomes from those in whom this association was not observed, supporting its potential as an imaging biomarker to inform individualized treatment decisions.
SN - 2694-5746
ER -