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Correlation of the apparent diffusion coefficient and the creatine level in early ischemic stroke: a comparison of
H Rumpel1, J B Khoo, H M Chang
1Department of Diagnostic Radiology, Singapore General Hospital, Singapore. rumpel@pacific.net.sg
Insights
Apparent diffusion coefficient (ADC) in stroke lesions correlates with cell density, measured by creatine (Cre) levels. Lower ADC indicates higher cell density, offering insights into stroke progression.
Area of Science:
- Neurology
- Radiology
- Biochemistry
Background:
- Apparent diffusion coefficient (ADC) reduction post-stroke is temporary, followed by abnormally high levels.
- Understanding cellular changes in stroke lesions is crucial for assessing disease stage.
Purpose of the Study:
- To evaluate ADC values in stroke lesions.
- To compare ADC values with lesion cellular density using creatine (Cre) levels.
Main Methods:
- Diffusion-weighted echo-planar and fast spin-echo imaging for lesion-to-contralateral ADC ratios (ADCn).
- Single-voxel localized spectroscopy for quantifying cerebral metabolites and comparing them to contralateral regions.
- Examined 15 ischemic stroke patients 18-88 hours post-symptom onset.
Main Results:
- Significant correlation found between ADC and Cre level in stroke lesions (higher cell density correlated with lower ADC).
- ADCn showed strong relationships with lesion Cre concentration (R²=0.70) and lesion-to-contralateral Cre ratio (R²=0.58).
- Low ADC values are associated with stable cellularity in stroke lesions.
Conclusions:
- ADC accurately reflects cell density in stroke lesions.
- ADC and Cre levels provide complementary information for characterizing stroke lesion stages.
- This two-parameter approach aids in understanding the underlying cellular status of stroke.
Abstract:
It has been reported that reduction of the apparent diffusion coefficient (ADC) after stroke can persist for several days, after which the ADC increases gradually to an abnormally high level. We evaluated ADC values of stroke lesions and compared the results to the cellular density of the lesion by means of the creatine (Cre) level. This two-parameter estimation is of particular relevance in ascertaining the underlying cellular status. Lesion-to-contralateral ADC ratios (ADCn) were obtained based on diffusion-weighted echo-planar and fast spin-echo imaging. Single-voxel localized spectroscopy was used for quantification of cerebral metabolites in infarcted regions. Their levels were also compared to that in homotopic contralateral regions. Fifteen patients with ischemic stroke were examined at times ranging from 18-88 hours following the onset of symptoms. In the stroke lesion, there was a significant correlation between the ADC and the Cre level showing that the higher the cell density the lower the ADC value. For ADCn vs. the lesion Cre concentration and the lesion-to-contralateral Cre ratio (Cre(n)), the strengths of relationship were R2 = 0.70 and 0.58, respectively. It is concluded that ADC is a good reflection of cell density. Greatly lowered ADC values occur within the context of a stable cellularity. ADC and the Cre level have complementary roles in the characterization of stroke lesion with regard to the sequential stage.