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Acute MRI changes in progressive ischemic stroke

E Kalowska1, E Rostrup, S Rosenbaum

  • 1Danish Research Center of Magnetic Resonance, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. e_kalowska@dadlnet.dk

European Neurology
|February 12, 2008
PubMed
Abstract

Insights

Acute stroke progression (SIP) is linked to lesion volume growth. Larger initial lesion size predicts SIP in lacunar infarcts, while baseline Scandinavian Stroke Scale (SSS) scores predict SIP in territorial infarcts.

Area of Science:

  • Neurology
  • Radiology
  • Neuroscience

Background:

  • Neurological deterioration after acute stroke, known as stroke in progression (SIP), is common and impacts patient outcomes.
  • The mechanisms driving SIP are not fully understood, hindering accurate prediction of at-risk individuals.
  • Predicting SIP is crucial for timely intervention and improved patient management.

Purpose of the Study:

  • To evaluate the utility of acute magnetic resonance imaging (MRI) findings in predicting stroke in progression (SIP).
  • To identify early imaging biomarkers associated with neurological deterioration post-stroke.
  • To differentiate predictors of SIP in lacunar versus territorial infarcts.

Main Methods:

  • Prospective study of 41 acute stroke patients (13 lacunar, 28 territorial) admitted within 24 hours.
  • Serial Diffusion-Weighted Imaging (DWI), perfusion imaging, and MRA performed at baseline, day 7, and 3 months.
  • Clinical neurological assessments (Scandinavian Stroke Scale - SSS) conducted frequently in the acute phase and during follow-up.

Main Results:

  • Fifteen patients (37%) developed SIP, characterized by significant neurological decline.
  • Increased DWI lesion volume at day 7 correlated with SIP across all stroke types.
  • In lacunar infarcts, baseline DWI lesion volume >1.5 cm³ predicted SIP (p < 0.005).
  • For territorial infarcts, lower baseline SSS scores were associated with SIP, and logistic regression identified baseline SSS as an independent predictor.

Conclusions:

  • Stroke in progression (SIP) appears related to lesion volume expansion between baseline and day 7.
  • Initial lesion size is a key predictor of SIP in lacunar infarcts.
  • Baseline Scandinavian Stroke Scale (SSS) score is the strongest individual predictor of SIP and clinical outcome in territorial infarcts.

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