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Prognostic value of perfusion- and diffusion-weighted MR imaging in first 3 days of stroke
M Kluytmans1, K J van Everdingen, L J Kappelle
1Department of Radiology, Image Sciences Institute, University Hospital Utrecht, The Netherlands.
Abstract:
The aim of this study was to evaluate the differences in cerebral perfusion seen on mean transit time (MTT) and cerebral blood volume (CBV) maps and to assess the subsequent prognostic value of the MTT-DWI (diffusion-weighted MRI) and CBV-DWI mismatch in the first three days of stroke on lesion enlargement and clinical outcome. In 38 patients, imaged 1-46 h after onset of symptoms, lesion volumes on proton-density (PD)-weighted MRI, DWI and PWI (both MTT and CBV maps) were compared with lesion volumes on follow-up PD-weighted scans, and to clinical outcome (National Institutes of Health Stroke Scale, Barthel index, and Rankin scale). The MTT-CBV, MTT-DWI and CBV-DWI mismatches were compared with change in lesion volume between initial and follow-up PD-weighted scans. Lesion volume on both DWI and PWI correlated significantly with clinical outcome parameters (p < 0.001) with strongest correlation for lesion volume on CBV. Perfusion-diffusion mismatches were found for both CBV and MTT and correlated significantly with lesion enlargement on PDweighted imaging with strongest correlation for the CBV-DWI mismatch. The CBV-DWI mismatch has the highest accuracy in predicting lesion size on follow-up imaging and in predicting clinical outcome. Lesion volume measurements on CBV maps have a higher specificity than on PD-weighted, MTT or DWI images in predicting clinical follow-up imaging and in predicting clinical outcome.
Insights
Cerebral blood volume (CBV) and mean transit time (MTT) maps, particularly the CBV-DWI mismatch, accurately predict stroke lesion growth and clinical outcomes within three days of stroke onset.
Area of Science:
- Neuroimaging
- Stroke Research
- Medical Diagnostics
Background:
- Stroke is a leading cause of long-term disability.
- Early and accurate prognostication is crucial for stroke management.
- Diffusion-weighted MRI (DWI) and perfusion-weighted imaging (PWI) are key tools in acute stroke assessment.
Purpose of the Study:
- To compare cerebral perfusion on mean transit time (MTT) and cerebral blood volume (CBV) maps.
- To assess the prognostic value of MTT-DWI and CBV-DWI mismatch for lesion enlargement and clinical outcome within three days post-stroke.
Main Methods:
- 38 stroke patients were imaged 1-46 hours after symptom onset.
- Lesion volumes on PD-weighted MRI, DWI, and PWI (MTT and CBV maps) were compared with follow-up scans and clinical outcomes (NIHSS, BI, Rankin).
- Perfusion-diffusion mismatches (MTT-CBV, MTT-DWI, CBV-DWI) were analyzed against lesion volume changes.
Main Results:
- Lesion volumes on DWI and PWI significantly correlated with clinical outcomes (p < 0.001), with CBV showing the strongest correlation.
- Perfusion-diffusion mismatches correlated significantly with lesion enlargement, particularly the CBV-DWI mismatch.
- The CBV-DWI mismatch demonstrated the highest accuracy in predicting follow-up lesion size and clinical outcome.
Conclusions:
- CBV-DWI mismatch is a highly accurate predictor of stroke lesion progression and clinical outcome.
- CBV map lesion volume measurements offer superior specificity for predicting clinical outcomes compared to PD-weighted, MTT, or DWI images.