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Related Experiment Videos

Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis.

Poh-Sien Loh1, Ken S Butcher, Mark W Parsons

  • 1Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Stroke
|November 5, 2005
PubMed
Summary
This summary is machine-generated.

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Intravenous tissue plasminogen activator (tPA) may lower the apparent diffusion coefficient (ADC) threshold for infarction in acute stroke patients. However, the fate of tissue with intermediate ADC values remains variable and unpredictable using ADC alone.

Area of Science:

  • Neurology
  • Radiology
  • Biomedical Imaging

Background:

  • Established apparent diffusion coefficient (ADC) thresholds exist for identifying tissue infarction in acute stroke.
  • Intravenous tissue plasminogen activator (tPA) is a recognized treatment for promoting tissue salvage in acute stroke.
  • The study investigates the potential impact of tPA on the ADC threshold for infarction.

Purpose of the Study:

  • To test the hypothesis that tPA treatment lowers the ADC threshold for infarction in acute stroke.
  • To evaluate the relationship between tPA administration and tissue salvage markers.

Main Methods:

  • Generated apparent diffusion coefficient (ADC) and mean transit time (MTT) maps for 26 acute stroke patients (12 tPA, 14 controls) within 6 hours of onset.
  • Coregistered MTT maps and day-90 T2-weighted images to ADC maps for analysis.

Related Experiment Videos

  • Calculated relative ADC (rADC) for initial diffusion-weighted imaging (DWI) lesions, infarct growth, and hypoperfused salvaged (HS) regions.

    • Main Results:

    • Mean DWI lesion rADC was slightly higher in tPA-treated patients (0.79) versus controls (0.74), though not statistically significant (P=0.097).
    • Mean rADC in hypoperfused salvaged (HS) and infarct growth regions were similar between tPA and control groups.
    • rADC in HS tissue positively correlated with time to tPA treatment (r=0.685; P=0.029). DWI reversal occurred more frequently in tPA-treated patients (67%) than controls (36%).

    Conclusions:

    • The region surrounding diffusion-weighted imaging (DWI) lesions contains tissue with intermediate ADC values, whose fate is variable.
    • ADC values alone cannot reliably predict the outcome of this peri-lesional tissue.
    • DWI expansion occurs in viable tissue and is attenuated by tPA in a time-dependent manner.