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Updated: Aug 25, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Acute ischemic stroke: predictive value of 2D phase-contrast MR angiography--serial study with combined diffusion and
Yawu Liu1, Jari O Karonen, Ritva L Vanninen
1Department of Clinical Radiology, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland. yawu.liu@kuh.fi
Purpose:
To evaluate phase-contrast magnetic resonance (MR) angiography and diffusion- and perfusion-weighted imaging in predicting evolution of infarction and clinical outcome.
Materials And Methods:
Phase-contrast angiographic and diffusion-weighted images obtained 1 and 2 days after acute middle cerebral artery (MCA) stroke were assessed in 43 patients; 39 underwent perfusion-weighted imaging on day 1. Follow-up phase-contrast angiographic and T2-weighted images (n = 38) were obtained on day 8. Clinical outcome was assessed at 3 months. Patients were assigned to three groups according to angiographic findings on day 1: group 1, absence of flow in proximal MCA (M1 segment); group 2, internal carotid artery (ICA) occlusion with collateral M1 flow; group 3, flow in ICA and M1. Differences in lesion volumes on diffusion- and perfusion-weighted maps among groups were compared with one-way analysis of variance with Tukey post hoc multiple comparisons.
Results:
Patients in group 1 had significantly larger infarct growth, volumes of hypoperfusion on relative cerebral blood volume (rCBV) and relative cerebral blood flow maps, and initial and final infarct volumes than did other patients (P <.05). Initial perfusion deficits on mean transit time maps were significantly (P =.002) larger in group 2 than in group 3, but there were no significant differences in infarct growth (P =.977), final infarct volume on day 8 (P =.947), and clinical outcome (P =.969). Absence of M1 flow on day 1 was significantly associated with unfavorable clinical outcome (modified Rankin score > or = 3) at 3 months (P =.010, chi(2) test). Discriminant analysis revealed that rCBV maps alone and combination of diffusion-weighted imaging and MR angiography yielded the highest accuracy in predicting an unfavorable clinical outcome.
Conclusion:
Phase-contrast MR angiography can provide complementary information to that with diffusion- and perfusion- weighted imaging in predicting the outcome of patients with acute stroke.
Insights
Phase-contrast MR angiography combined with diffusion and perfusion imaging accurately predicts stroke outcomes. Absence of middle cerebral artery flow on day 1 indicates larger infarcts and poor clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute stroke management requires accurate prediction of infarct evolution and clinical outcome.
- Advanced neuroimaging techniques are crucial for assessing ischemic brain tissue.
Purpose of the Study:
- To evaluate phase-contrast MR angiography (MRA) and diffusion- and perfusion-weighted imaging (PWI) in predicting stroke evolution and clinical outcome.
- To determine the added value of MRA in conjunction with diffusion-weighted imaging (DWI) and PWI.
Main Methods:
- 43 acute middle cerebral artery (MCA) stroke patients underwent DWI and MRA on days 1-2 and follow-up imaging on day 8.
- 39 patients had perfusion-weighted imaging (PWI) on day 1.
- Patients were grouped by M1 segment MCA flow on day 1: absent (Group 1), collateral (Group 2), or normal (Group 3).
- Infarct volumes and clinical outcomes at 3 months were analyzed using ANOVA and discriminant analysis.
Main Results:
- Group 1 (no M1 flow) showed significantly larger infarct growth, hypoperfusion volumes (rCBV, rCBF), and infarct volumes compared to other groups (P < .05).
- Initial perfusion deficits on mean transit time (MTT) maps were larger in Group 2 vs. Group 3 (P = .002), but infarct growth and final volumes did not differ.
- Absence of M1 flow on day 1 significantly predicted unfavorable clinical outcome (modified Rankin score ≥ 3) at 3 months (P = .010).
- Discriminant analysis indicated that relative cerebral blood volume (rCBV) maps and the combination of DWI and MRA provided the highest accuracy for predicting unfavorable outcomes.
Conclusions:
- Phase-contrast MRA provides complementary information to DWI and PWI for predicting acute stroke outcomes.
- Early identification of absent M1 flow is a strong predictor of poor clinical prognosis.
- Combining MRA with DWI and PWI enhances the accuracy of outcome prediction in acute stroke patients.