Specific DWI lesion patterns predict prognosis after acute ischaemic stroke within the MCA territory

Area of Science:

• Neuroradiology
• Neurology
• Stroke Medicine

Background:

• Limited understanding of neuroradiological predictors for early ischemic stroke prognosis beyond lesion volume and perfusion mismatch.
• Need for identifying specific diffusion-weighted imaging (DWI) lesion patterns for predicting early outcomes.

Purpose of the Study:

• To identify specific DWI lesion patterns for predicting early prognosis after ischemic stroke.
• To evaluate DWI lesion patterns as predictors for unstable hospital course, stroke recurrence, and 90-day neurological outcome.

Main Methods:

• Prospective study of 426 patients with acute middle cerebral artery territory infarcts.
• Classification of patients into six DWI lesion pattern groups.
• Recording of recurrent strokes and 90-day prognosis.

Main Results:

• DWI lesion pattern is a stronger independent predictor of outcome than DWI lesion volume.
• Internal border zone infarcts associated with unstable hospital course.
• Small superficial infarcts linked to recurrent strokes; internal border zone infarcts associated with poor 90-day outcome.

Conclusions:

• DWI lesion patterns aid in recognizing differences in early prognostic endpoints after ischemic stroke.
• DWI analysis can guide targeted interventions to prevent negative outcomes.