Document Detail

Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging.
MedLine Citation:
PMID:  12855829     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI). METHODS: Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient <80% (ADC<80%) and time to peak >+4 seconds (TTP>+4s) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADCcore) and relative ADC within the ADC<80% lesion (rADClesion) were measured. Neurological deficit at admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). RESULTS: Patients with MMI showed larger ADC<80% (median, 157 versus 22 mL; P<0.001) and TTP>+4s (208 versus 125 mL; P<0.001) lesion volumes, smaller TTP/ADC mismatch ratio (1.5 versus 5.5; P<0.001), lower ADCcore values (290 versus 411 mm2/s; P<0.001), lower rADClesion (0.60 versus 0.66; P=0.001), higher frequency of carotid-T occlusion (64% versus 15%; P=0.006), and higher NIHSS score at admission (20 versus 15; P=0.001). Predictors of MMI were as follows for sensitivity and specificity, respectively: ADC<80% >82 mL, 87%, 91%; TTP>+4s >162 mL, 83%, 75%; TTP/ADC mismatch ratio <2.4, 80%, 79%; ADCcore <300 mm2/s, 83%, 85%; rADClesion <0.62, 79%, 74%; and NIHSS score at admission > or =19, 96%, 72%. CONCLUSIONS: Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.
Götz J Thomalla; Thomas Kucinski; Volker Schoder; Jens Fiehler; Rene Knab; Herrmann Zeumer; Cornelius Weiller; Joachim Röther
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-07-10
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  34     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-01     Completed Date:  2003-09-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1892-9     Citation Subset:  IM    
Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrabetae 52, D-20246 Hamburg, Germany.
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MeSH Terms
Aged, 80 and over
Brain / blood supply
Cerebrovascular Circulation
Decompression, Surgical
Diffusion Magnetic Resonance Imaging* / methods
Disease Progression
Infarction, Middle Cerebral Artery / diagnosis*,  physiopathology*,  therapy
Magnetic Resonance Angiography* / methods
Middle Aged
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Survival Rate
Thrombolytic Therapy
Time Factors
Comment In:
Stroke. 2003 Aug;34(8):1899-900   [PMID:  12855828 ]

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

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