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Predictors of apparent diffusion coefficient normalization in stroke patients.

Jens Fiehler1, Karina Knudsen, Thomas Kucinski

  • 1Department of Neuroradiology, University Hospital Eppendorf, University of Hamburg, Hamburg, Germany. fiehler@uke.uni-hamburg.de

Stroke
|January 24, 2004
PubMed
Summary
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Apparent diffusion coefficient (ADC) normalization in acute stroke is common, particularly within 3 hours of symptom onset. This suggests that brain tissue with initially decreased ADC may represent viable tissue at risk.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Hyperacute stroke is characterized by decreased apparent diffusion coefficient (ADC) values.
  • Understanding the dynamics of ADC normalization is crucial for identifying salvageable brain tissue.

Purpose of the Study:

  • To determine the frequency of ADC value normalization in hyperacute stroke.
  • To identify characteristics of brain tissue that demonstrates ADC normalization.

Main Methods:

  • Sixty-eight acute ischemic stroke patients underwent serial MRI scans (diffusion/perfusion imaging, MR angiography) within 6 hours of symptom onset, at 24 hours, and 4-7 days later.
  • Lesion volumes with decreased ADC and delayed time to peak (TTP) in perfusion imaging were quantified.
  • Patients were classified as normalizers (>5 mL ADC normalization) or non-normalizers (<5 mL ADC normalization).

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Main Results:

  • ADC normalization occurred in 19.7% of patients (14/68).
  • Normalization was more frequent in patients imaged within 3 hours (35.5%) versus 3-6 hours (7.5%) of stroke onset.
  • Normalization was observed in basal ganglia and white matter, often associated with reperfusion and more distal occlusions; less severe initial ADC decrease predicted normalization.

Conclusions:

  • Apparent diffusion coefficient normalization is a frequent occurrence in acute stroke patients who experience reperfusion.
  • Brain tissue exhibiting decreased ADC within 3 hours of stroke onset may represent tissue at risk and potentially salvageable.