Objective: In acute ischemic stroke, early neurological deterioration (END) may occur
in up to one-third of patients. However, there is still no satisfying or comprehensive predictive
model for all the stroke subtypes. We propose a practical model to predict END using magnetic
resonance imaging (MRI).
Method: Patients with anterior circulation infarct were recruited and they underwent an MRI
within 24 hours of stroke onset. END was defined as an elevation of ≥2 points on the National Institute
of Health Stroke Scale (NIHSS) within 72 hours of stroke onset. We examined the relationships
of END to individual END models, including: A, infarct swelling; B, small subcortical infarct;
C, mismatch; and D, recurrence.
Results: There were 163 patients recruited and 43 (26.4%) of them had END. The END models A,
B and C significantly predicted END respectively after adjusting for confounding factors
(p=0.022, p=0.007 and p<0.001 respectively). In END model D, we examined all imaging predictors
of Recurrence Risk Estimator (RRE) individually and only the “multiple acute infarcts” pattern
was significantly associated with END (p=0.032). When applying END models A, B, C and
D, they successfully predicted END (p<0.001; odds ratio: 17.5[95% confidence interval: 5.1–
60.8]), with 93.0% sensitivity, 60.0% specificity, 45.5% positive predictive value and 96.0% negative
Conclusion: The results demonstrate that the proposed model could predict END in all stroke subtypes
of anterior circulation infarction. It provides a practical model for clinical physicians to select
high-risk patients for more aggressive treatment to prevent END.