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Updated: Aug 13, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Apparent diffusion coefficient mapping of infarcted tissue and the ischaemic penumbra in acute stroke
M El-Koussy1, K O Lövblad, C Kiefer
1Department of Neuroradiology, University of Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland.
Abstract:
MRI assessment of diffusion changes in acute cerebral ischaemia necessitates analysis of the apparent diffusion coefficient (ADC). We used the concept of relative weighted mean ADC (rwmADC) to obtain an accurate estimate of the extent of infarcted tissue. We studied ten patient with of acute ischaemic stroke, using diffusion- and perfusion- weighted MRI. The rwmADC was used to calculate a corrected ADC-lesion volume (DLVR), which was compared with the diffusion-lesion volume (DLV), initial perfusion lesion volumes and the follow-up infarct volume on T2-weighted images. We looked at correlations between the MRI and clinical findings. DLVR was closest to the final infarct size and had the best clinicoradiological correlation (r=0.77). Weighting the mean ADC within the ischaemic and normal parenchyma can give a more correct estimate of the volume of infarcted brain parenchyma, thus improving the definition of the penumbra.
Insights
Accurate assessment of acute ischemic stroke using MRI requires analyzing the apparent diffusion coefficient (ADC). A new method, relative weighted mean ADC (rwmADC), provides a more precise estimate of infarct volume and better correlates with clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke assessment relies on MRI diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) analysis.
- Accurate estimation of infarct volume is crucial for patient management and treatment decisions.
Purpose of the Study:
- To introduce and validate a novel method, relative weighted mean ADC (rwmADC), for more accurate infarct volume quantification in acute ischemic stroke.
- To compare the accuracy of rwmADC-derived lesion volume (DLVR) with conventional diffusion-lesion volume (DLV) and final infarct size.
Main Methods:
- Diffusion- and perfusion-weighted MRI were performed on ten patients with acute ischemic stroke.
- The rwmADC was calculated and used to determine the corrected ADC-lesion volume (DLVR).
- DLVR was compared with DLV, initial perfusion lesion volumes, and follow-up infarct volume on T2-weighted images.
Main Results:
- The DLVR showed the closest correlation with the final infarct size (r=0.77).
- The rwmADC method provided a more accurate estimate of infarcted brain parenchyma volume.
- The DLVR demonstrated the best clinicoradiological correlation among the assessed metrics.
Conclusions:
- Weighting the mean ADC within ischemic and normal brain parenchyma improves the accuracy of infarct volume estimation.
- The rwmADC method enhances the definition of the ischemic penumbra, aiding in clinical decision-making.
- This approach offers a more reliable tool for assessing the extent of brain damage in acute ischemic stroke.
