Document Detail

Do acute diffusion- and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke?
MedLine Citation:
PMID:  16322499     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: An acute mismatch on diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) may represent the "tissue-at-risk." It is unclear which "semiquantitative" perfusion parameter most closely identifies final infarct volume. METHODS: Acute stroke patients underwent DWI and PWI (dynamic-susceptibility contrast imaging) on admission (baseline), and T2-weighted imaging (T2WI) at 1 or 3 months after stroke. "Semiquantitative" mean transit time (MTTsq=first moment of concentration/time curve), cerebral blood volume (CBVsq=area under concentration/time curve), and cerebral blood flow (CBFsq=CBVsq/MTTsq) were calculated. DWI and PWI lesions were measured at baseline and final infarct volume on T2WI acquired > or =1 month after stroke. Baseline DWI, CBFsq, and MTTsq lesion volumes were compared with final T2WI lesion volume. RESULTS: Among 46 patients, baseline DWI and CBFsq lesions were not significantly different from final T2WI lesion volume, but baseline MTTsq lesions were significantly larger. The correlation with final T2WI lesion volume was strongest for DWI (Spearman rank correlation coefficient rho=0.68), intermediate for CBFsq (rho=0.55), and weakest for MTTsq (rho=0.49) baseline lesion volumes. Neither DWI/CBFsq nor DWI/MTTsq mismatch predicted lesion growth; lesion growth was equally common in those with and without mismatch. CONCLUSIONS: Of the 2 PWI parameters, CBFsq lesions most closely identifies, and MTTsq overestimates, final T2WI lesion volume. "DWI/PWI mismatch" does not identify lesion growth. Patients without "DWI/PWI mismatch" are equally likely to have lesion growth as those with mismatch and should not be excluded from acute stroke treatment.
C S Rivers; J M Wardlaw; P A Armitage; M E Bastin; T K Carpenter; V Cvoro; P J Hand; M S Dennis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-12-01
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  37     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-23     Completed Date:  2006-02-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-104     Citation Subset:  IM    
Division of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK.
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MeSH Terms
Aged, 80 and over
Cerebrovascular Circulation
Diffusion Magnetic Resonance Imaging / methods*
Image Processing, Computer-Assisted
Ischemia / diagnosis,  pathology*
Magnetic Resonance Imaging / methods*
Middle Aged
Models, Statistical
Prospective Studies
Stroke / diagnosis,  pathology*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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