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Updated: Aug 18, 2026
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Predicting final infarct size using acute and subacute multiparametric MRI measurements in patients with ischemic
Mei Lu1, Panayiotis D Mitsias, James R Ewing
1Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan 48202, USA. mlu1@hfhs.org
Purpose:
To identify early MRI characteristics of ischemic stroke that predict final infarct size three months poststroke.
Materials And Methods:
Multiparametric MRI (multispin echo T2-weighted [T2W] imaging, T1-weighted [T1W] imaging, and diffusion-weighted imaging [DWI]) was performed acutely (<24 hours), subacutely (three to five days), and at three months. MRI was processed using maps of apparent diffusion coefficient (ADC), T2, and a self-organizing data analysis (ISODATA) technique. Analyses began with testing for individual MRI parameter effects, followed by multivariable modeling with assessment of predictive ability (R(2)) on final infarct size.
Results:
A total of 45 patients were studied, 15 of whom were treated with tissue plasminogen activator (tPA) before acute MRI. The acute DWI and DWI-ISODATA mismatch lesion size, and the interactions of ADC, T2, and T2W imaging lesion with tPA remained in the final multivariable model (R(2) = 70%). A large acute DWI lesion or DWI < ISODATA lesion independently predicted increase in the final infract size, with predictive ability 68%. Predictive ability increased (R(2) = 83%) when subacute MRI parameters were included along with acute DWI, DWI-ISODATA mismatch, and acute T2W image lesion size by tPA treatment interaction. Subacute DWI > acute DWI lesion size predicted an increased final infarct size (P < 0.01).
Conclusion:
Acute-phase DWI and DWI-ISODATA mismatch strongly predict the final infarct size. An acute-to-subacute DWI lesion size change further increases the predictive ability of the model.
Insights
Early MRI using diffusion-weighted imaging (DWI) and DWI-ISODATA mismatch accurately predicts final ischemic stroke infarct size. Changes in lesion size from acute to subacute phases further improve prediction accuracy.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Ischemic stroke outcomes are influenced by infarct size.
- Predicting final infarct size early is crucial for treatment and prognosis.
Purpose of the Study:
- To identify early magnetic resonance imaging (MRI) characteristics that predict final infarct size in ischemic stroke patients three months post-stroke.
Main Methods:
- Multiparametric MRI, including diffusion-weighted imaging (DWI), T2-weighted (T2W), and T1-weighted (T1W) imaging, was performed acutely, subacutely, and at three months.
- MRI data were analyzed using apparent diffusion coefficient (ADC) maps, T2 maps, and a self-organizing data analysis (ISODATA) technique.
- Multivariable modeling assessed the predictive ability of MRI parameters on final infarct size.
Main Results:
- Acute DWI and DWI-ISODATA mismatch lesion size were significant predictors of final infarct size (R(2) = 70%).
- A larger acute DWI lesion or a DWI lesion smaller than the ISODATA lesion independently predicted increased final infarct size (predictive ability 68%).
- Inclusion of subacute MRI parameters, along with acute DWI, DWI-ISODATA mismatch, and T2W lesion size by tPA treatment interaction, increased predictive ability to 83%.
Conclusions:
- Acute-phase DWI and DWI-ISODATA mismatch are strong predictors of final ischemic stroke infarct size.
- The change in DWI lesion size from the acute to subacute phase further enhances the predictive accuracy of the model.
