Border-zone Infarction on Diffusion-weighted Imaging for Etiological Stratification of Anterior Circulation Large Vessel Occlusion
- 1Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
- 2Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Nagoya, Aichi, Japan
- 3Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Hiroshima, Japan
Abstract
Accurate differentiation of intracranial atherosclerotic disease-related large vessel occlusion from cardioembolic large vessel occlusion is important for understanding stroke etiology and optimizing endovascular treatment strategies. Although computed tomography-based diagnostic models have been proposed, magnetic resonance imaging-based models remain less well established. This study investigated the diagnostic value of border-zone infarction on diffusion-weighted imaging and evaluated predictive models incorporating border-zone infarction for identifying intracranial atherosclerotic disease-related large vessel occlusion. We retrospectively analyzed consecutive patients who underwent endovascular treatment for anterior circulation large vessel occlusion between April 2015 and April 2025. Intracranial atherosclerotic disease-related large vessel occlusion was defined as >50% residual stenosis after thrombectomy, or when dynamic intraprocedural re-occlusion occurred after initial reperfusion that was indicative of in situ thrombosis. Diagnostic performance of the ABC2D score was evaluated and compared with models incorporating border-zone infarction. Among 149 patients, 24 (16%) had intracranial atherosclerotic disease-related large vessel occlusion. Multivariable analysis identified absence of atrial fibrillation, absence of the hyperdense artery sign, and presence of border-zone infarction as independent predictors of intracranial atherosclerotic disease-related large vessel occlusion. Border-zone infarction indicated high specificity (94%) and the highest positive predictive value (64%). The ABC2D model achieved an area under the curve of 0.837, which improved to 0.912 with the addition of border-zone infarction. Furthermore, a simplified 2-variable model comprising only the absence of atrial fibrillation and the presence of border-zone infarction showed a high practical discriminative ability (area under the curve, 0.883). Border-zone infarction on diffusion-weighted imaging is a highly specific marker for intracranial atherosclerotic disease-related large vessel occlusion that significantly improves established computed tomography-based diagnostic models. A simplified 2-variable model (atrial fibrillation absence and border-zone infarction) offers a practical tool for rapid etiological triage. Prospective multicenter validation is warranted.
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BibTeX
@article{hashimoto2026borderzone,
title = {{Border-zone Infarction on Diffusion-weighted Imaging for Etiological Stratification of Anterior Circulation Large Vessel Occlusion}},
author = {Yukishige HASHIMOTO and Fusao IKAWA and Reo KAWANO and Toshikazu HIDAKA and Yusuke INOUE and Yusuke YAMAMOTO and Nobutaka HORIE},
journal = {Neurologia medico-chirurgica},
year = {2026},
month = sep,
doi = {10.2176/jns-nmc.2026-0103},
url = {https://doi.org/10.2176/jns-nmc.2026-0103},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Border-zone Infarction on Diffusion-weighted Imaging for Etiological Stratification of Anterior Circulation Large Vessel Occlusion
AU - Yukishige HASHIMOTO
AU - Fusao IKAWA
AU - Reo KAWANO
AU - Toshikazu HIDAKA
AU - Yusuke INOUE
AU - Yusuke YAMAMOTO
AU - Nobutaka HORIE
PY - 2026
DA - 2026/09/09
JO - Neurologia medico-chirurgica
DO - 10.2176/jns-nmc.2026-0103
UR - https://doi.org/10.2176/jns-nmc.2026-0103
AB - Accurate differentiation of intracranial atherosclerotic disease-related large vessel occlusion from cardioembolic large vessel occlusion is important for understanding stroke etiology and optimizing endovascular treatment strategies. Although computed tomography-based diagnostic models have been proposed, magnetic resonance imaging-based models remain less well established. This study investigated the diagnostic value of border-zone infarction on diffusion-weighted imaging and evaluated predictive models incorporating border-zone infarction for identifying intracranial atherosclerotic disease-related large vessel occlusion. We retrospectively analyzed consecutive patients who underwent endovascular treatment for anterior circulation large vessel occlusion between April 2015 and April 2025. Intracranial atherosclerotic disease-related large vessel occlusion was defined as >50% residual stenosis after thrombectomy, or when dynamic intraprocedural re-occlusion occurred after initial reperfusion that was indicative of in situ thrombosis. Diagnostic performance of the ABC2D score was evaluated and compared with models incorporating border-zone infarction. Among 149 patients, 24 (16%) had intracranial atherosclerotic disease-related large vessel occlusion. Multivariable analysis identified absence of atrial fibrillation, absence of the hyperdense artery sign, and presence of border-zone infarction as independent predictors of intracranial atherosclerotic disease-related large vessel occlusion. Border-zone infarction indicated high specificity (94%) and the highest positive predictive value (64%). The ABC2D model achieved an area under the curve of 0.837, which improved to 0.912 with the addition of border-zone infarction. Furthermore, a simplified 2-variable model comprising only the absence of atrial fibrillation and the presence of border-zone infarction showed a high practical discriminative ability (area under the curve, 0.883). Border-zone infarction on diffusion-weighted imaging is a highly specific marker for intracranial atherosclerotic disease-related large vessel occlusion that significantly improves established computed tomography-based diagnostic models. A simplified 2-variable model (atrial fibrillation absence and border-zone infarction) offers a practical tool for rapid etiological triage. Prospective multicenter validation is warranted.
SN - 0470-8105
SN - 1349-8029
ER -