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Is there an apparent diffusion coefficient threshold in predicting tissue viability in hyperacute stroke?

C Oppenheim1, C Grandin, Y Samson

  • 1Department of Medical Imaging, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium. oppenheim@chsa.broca.inserm.fr

Stroke
|November 3, 2001
PubMed
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A moderate decrease in apparent diffusion coefficient (ADC) can identify tissue at risk of infarction in acute stroke patients. This finding aids in predicting stroke evolution and guiding treatment decisions.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Accurate identification of the penumbra is crucial for acute stroke management.
  • Diffusion/Perfusion (DWI/PWI) mismatch helps identify at-risk brain tissue.

Purpose of the Study:

  • To determine if a moderate decrease in apparent diffusion coefficient (ADC) can predict eventual infarction within the DWI/PWI mismatch.
  • To assess the utility of ADC values in differentiating tissue outcomes in acute stroke.

Main Methods:

  • Reviewed 48 patients with acute stroke not treated with thrombolytics.
  • Calculated ADC and ADC ratio (ADCr) in initial DWI lesions, final infarcts, infarct growth (IGR) areas, and oligemic (OLI) areas.
  • Used discriminant analysis to test ADC's predictive value for tissue outcome.

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Main Results:

  • ADC values were significantly lower in the infarct growth (IGR) area compared to oligemic (OLI) areas.
  • The ADC ratio (ADCr) effectively discriminated between IGR and OLI, and between final infarct volume and OLI.
  • ADCr showed high sensitivity and specificity in predicting tissue outcome.

Conclusions:

  • Apparent diffusion coefficient (ADC) alone can identify tissue at risk of infarction in acute stroke.
  • This simple ADC-based approach aids in predicting stroke evolution and potential infarct expansion.