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Updated: Aug 9, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging
C Oppenheim1, Y Samson, R Manaï
1Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Background And Purpose:
This study was designed to analyze whether early diffusion-weighted imaging (DWI) provides reliable quantitative information for the prediction of stroke patients at risk of malignant brain infarct.
Methods:
We selected 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MRI angiography performed within 14 hours after onset (mean 6.5+/-3.5 hours, median 5.2 hours). Of these, 10 patients developed malignant MCA infarct, whereas 18 did not. For the 2 groups, we compared the National Institutes of Health Stroke Scale (NIHSS) score at admission, site of arterial occlusion, standardized visual analysis of DWI abnormalities, quantitative volume measurement of DWI abnormalities (volume(DWI)), and apparent diffusion coefficient values. Univariate and multivariate discriminant analysis was used to determine the most accurate predictors of malignant MCA infarct.
Results:
Univariate analysis showed that an admission NIHSS score >20, total versus partial MCA infarct, and volume(DWI) >145 cm(3) were highly significant predictors of malignant infarct. The best predictor was volume(DWI) >145 cm(3), which achieved 100% sensitivity and 94% specificity. Prediction was further improved by bivariate models combining volume(DWI) and apparent diffusion coefficient measurements, which reached 100% sensitivity and specificity in this series of patients.
Conclusions:
Quantitative measurement of infarct volume on DWI is an accurate method for the prediction of malignant MCA infarct in patients with persistent arterial occlusion imaged within 14 hours of onset. This may be of importance for early management of severe stroke patients.
Insights
Quantitative diffusion-weighted imaging (DWI) accurately predicts malignant middle cerebral artery (MCA) infarct in stroke patients within 14 hours of onset. This early prediction using infarct volume on DWI aids in managing severe stroke cases.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Malignant brain infarct poses a significant risk in stroke patients.
- Early identification of patients at risk is crucial for timely intervention.
Purpose of the Study:
- To evaluate the reliability of early diffusion-weighted imaging (DWI) for predicting malignant brain infarct.
- To determine if quantitative DWI metrics can identify stroke patients at high risk.
Main Methods:
- 28 middle cerebral artery (MCA) infarct patients with arterial occlusion within 14 hours of onset were analyzed.
- Compared National Institutes of Health Stroke Scale (NIHSS) scores, DWI abnormalities, infarct volume (volume(DWI)), and apparent diffusion coefficient (ADC) values between malignant and non-malignant infarct groups.
- Utilized univariate and multivariate discriminant analysis to identify predictors of malignant MCA infarct.
Main Results:
- Admission NIHSS score >20, total MCA infarct, and volume(DWI) >145 cm³ were significant predictors.
- Infarct volume (volume(DWI)) >145 cm³ demonstrated 100% sensitivity and 94% specificity for predicting malignant infarct.
- Combining volume(DWI) with ADC measurements achieved 100% sensitivity and specificity.
Conclusions:
- Quantitative DWI infarct volume measurement is a reliable method for predicting malignant MCA infarct.
- Early DWI imaging within 14 hours of onset is valuable for identifying high-risk stroke patients.
- This quantitative approach can inform early management strategies for severe stroke.
