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Does reversal of ischemia on diffusion-weighted imaging reflect higher apparent diffusion coefficient values?
H L Lutsep1, G M Nesbit, R M Berger
1Oregon Stroke Center, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, CR 131, Portland, OR 97201, USA. lutseph@ohsu.edu
Summary
Reversible ischemic lesions on diffusion-weighted imaging (DWI) show higher apparent diffusion coefficients (ADCs). This suggests that thrombolytic therapy can lead to significant lesion reversal in stroke patients.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Diffusion-weighted imaging (DWI) is crucial for early stroke detection.
- Apparent diffusion coefficients (ADCs) quantify water diffusion in tissues, aiding in stroke characterization.
- Understanding lesion reversibility is key for assessing treatment efficacy.
Observation:
- Serial magnetic resonance imaging (MRI) was performed on a patient treated with thrombolytics.
- A large left frontoparietal stroke on baseline DWI significantly reduced in size by 4 weeks.
- Fluid attenuated inversion recovery (FLAIR) imaging showed substantial lesion resolution.
Findings:
- Regions of ischemia that reversed on DWI exhibited higher mean ADCs compared to persistent regions.
- The mean ADC in reversed areas was 7.43 x 10(-3) mm2/s versus 7.31 x 10(-3) mm2/s in persistent areas (P < .036).
- These findings indicate a correlation between higher ADCs and lesion reversibility post-thrombolysis.
Implications:
- Large ischemic lesions identified on DWI may be amenable to reversal with thrombolytic treatment.
- Higher ADCs in specific regions could predict lesion resolution.
- This research contributes to optimizing stroke treatment strategies and prognostic assessments.