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Updated: Oct 4, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Correlation between diffusion- and perfusion-weighted MRI and neurological deficit measured by the Scandinavian
L Røhl1, J Geday, L Østergaard
1Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark. Lisbeth@pet.auh.dk
Objective:
We used combined diffusion-weighted (DWI) and perfusion-weighted (PWI) MRI to characterize hyperacute infarctions within 6 h of symptom onset with special reference to subcortical infarctions, and investigated the relation between perfusion-diffusion mismatch volume and functional outcome.
Material And Methods:
Twenty-two patients presenting with symptoms of acute stroke underwent DWI and PWI within 6 h of symptom onset, and follow-up MRI 30 days later. Twelve of these had a subcortical infarction on acute DWI. Lesion volumes were measured by acute DWI and PWI as well as chronic T(2)-weighted MRI (T2WI). Clinical severity was measured by the Scandinavian Stroke Scale (SSS) and the Barthel Index (BI).
Results:
In the 12 patients with subcortical infarctions, PWI and especially DWI correlated strongly with acute and chronic neurological SSS score, as well as with final infarct volume. Furthermore, a hyperacute PWI/DWI mismatch in this subgroup predicted lesion growth. There was a weaker correlation between acute DWI/PWI and neurological score among all 22 patients, and patients with a PWI/DWI mismatch larger than 100 ml had a significantly larger lesion growth and a poorer outcome than patients with a smaller mismatch.
Conclusions:
Subcortical infarctions may represent a sizeable subgroup of acute stroke patients. Also subcortical infarctions may have a PWI/DWI mismatch and therefore may respond to neuroprotective/thrombolytic therapy. Hyperacute DWI may reflect the acute clinical status and predict the outcome in patients with subcortical infarction.
Insights
Hyperacute diffusion-weighted (DWI) and perfusion-weighted (PWI) MRI can identify subcortical infarctions within 6 hours of stroke onset. DWI accurately reflects acute clinical status and predicts outcomes in these patients.
Area of Science:
- Neuroradiology
- Neuroimaging
- Stroke Imaging
Background:
- Hyperacute infarctions require prompt characterization for effective treatment.
- Subcortical infarctions present unique diagnostic challenges.
- Assessing the relationship between imaging findings and functional outcomes is crucial.
Purpose of the Study:
- To characterize hyperacute subcortical infarctions using combined DWI and PWI MRI within 6 hours of symptom onset.
- To investigate the correlation between perfusion-diffusion mismatch volume and functional outcomes.
- To evaluate the predictive value of DWI for clinical status and outcomes in subcortical infarctions.
Main Methods:
- Twenty-two acute stroke patients underwent DWI and PWI within 6 hours of symptom onset.
- Twelve patients with subcortical infarctions were specifically analyzed.
- Lesion volumes were measured using acute DWI, PWI, and chronic T2WI; clinical severity was assessed using the Scandinavian Stroke Scale and Barthel Index.
Main Results:
- In subcortical infarctions, DWI and PWI strongly correlated with neurological scores and infarct volume.
- A hyperacute PWI/DWI mismatch predicted lesion growth in subcortical infarctions.
- Larger PWI/DWI mismatches (>100 ml) were associated with greater lesion growth and poorer outcomes.
Conclusions:
- Subcortical infarctions constitute a significant subgroup of acute stroke patients.
- Subcortical infarctions can exhibit PWI/DWI mismatch, suggesting potential responsiveness to neuroprotective/thrombolytic therapies.
- Hyperacute DWI is a valuable tool for assessing acute clinical status and predicting outcomes in subcortical infarction patients.
