Role of DWI-ASPECTS as a numerical predictive tool to prognosticate late daily dependence in acute ischemic stroke patients

Abstract Background This study intends to estimate the quantitative capability of the diffusion-weighted image (DWI) sequence in foretelling late daily dependence in patients presented with acute ischemic stroke along the middle cerebral artery (MCA) territory. DWI is not only able to detect acute ischemic insults but also can numerically estimate the affected areas by applying diffusion-weighted Alberta stroke program early computed tomography score (DWI-ASPECTS) and comparing these numerical values with the clinical status after 3 months, which is scaled by the modified Rankin Scale (mRS). The present prospective research was carried out at two stroke centers in Port Said governorate, Egypt, during the period between the beginning of May 2024 and the beginning of November 2024 upon 105 patients who presented with clinical manifestations of ischemic cerebrovascular insults and were proved by magnetic resonance imaging (MRI) examination to have acute ischemic insults affecting the MCA territory. Results In our study; 3 months after the initial ischemic attack, 35/105 patients (33.33%) showed late daily dependence, and the remaining 70 patients (66.67%) showed no significant disability. Throughout the group of late daily dependence, 30/35 patients (85.71%) had acquired DWI-ASPECTS ≤ 7 and throughout the group of no significant disability, only 5/70 patients (7.12%) had acquired DWI-ASPECTS ≤ 7, with a proved extremely positive significant statistical correlation between low DWI-ASPECTS and elevated numerical and categorical mRS data ( p ≤ 0.05). The estimated cutoff values of DWI-ASPECTS to suggest late daily dependence using ROC curve analysis were ≤ 7. Conclusion DWI-ASPECTS can be used as a numerical predictive tool to prognosticate late daily dependence in acute ischemic stroke patients along the MCA territory. DWI-ASPECTS ≤ 7 is the considered cutoff value.