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MR imaging in acute stroke: diffusion-weighted and perfusion imaging parameters for predicting infarct size
Hans-Jörg Wittsack1, Afra Ritzl, Gereon R Fink
1Department of Neurology, Heinrich-Heine University of Düsseldorf, MNR-Klinik/MRT-2, Moorenstrasse 5, D-40225 Düsseldorf, Germany. wittsackuni-duesseldorf.de
Radiology
|January 31, 2002
Summary
Diffusion-weighted imaging accurately predicts stroke infarct size in patients with symptom onset over 4 hours. For earlier onset, perfusion imaging offers crucial insights into brain tissue health.
Area of Science:
- Neuroimaging
- Stroke Imaging
- Radiology
Background:
- Accurate prediction of infarct size is crucial for stroke management.
- Early assessment of ischemic lesion volume aids in treatment decisions.
- Magnetic resonance (MR) imaging techniques offer insights into acute stroke pathophysiology.
Purpose of the Study:
- To evaluate the predictive capability of acute diffusion-weighted imaging (DWI) and perfusion imaging (time-to-peak, TTP) for final infarct size.
- To compare these acute imaging metrics with post-acute T2-weighted imaging outcomes.
- To analyze the influence of time from symptom onset to imaging on predictive accuracy.
Main Methods:
- Fifty acute stroke patients underwent DWI and perfusion imaging within 24 hours of symptom onset.
- Follow-up T2-weighted imaging was performed approximately 8 days post-stroke.
- Lesion volumes were quantified using semiautomatic thresholding techniques.
Main Results:
- Acute DWI lesion volume demonstrated the strongest correlation with 1-week infarct size.
- A time-to-peak delay exceeding 6 seconds on perfusion maps was a significant predictor.
- Patient subgroups based on symptom onset time ( 4 hours) showed differential imaging performance.
Conclusions:
- DWI effectively predicts infarct size in patients with symptom onset >4 hours (r=0.96).
- For symptom onset <4 hours, perfusion imaging provides valuable additional information on impaired brain tissue.
- Combining DWI and perfusion imaging may optimize infarct size prediction across different time windows.