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Lesion Explorer: A Video-guided, Standardized Protocol for Accurate and Reliable MRI-derived Volumetrics in Alzheimer's Disease and Normal Elderly
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Lesion Explorer: A Video-guided, Standardized Protocol for Accurate and Reliable MRI-derived Volumetrics in Alzheimer's Disease and Normal Elderly

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Lesion volume increase is related to neurologic progression in patients with subcortical infarction

Kyung-Hee Cho1, Dong-Wha Kang, Sun U Kwon

  • 1Stroke Center and Department of Neurology, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.

Journal of the Neurological Sciences
|June 6, 2009
PubMed

Insights

Subacute lesion volume growth after a middle cerebral artery territory stroke predicts neurological worsening and poor clinical outcomes. Monitoring infarct expansion on MRI is crucial for predicting patient prognosis.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • The relationship between subacute lesion volume increase and neurological progression or clinical outcomes in single subcortical infarct (SSI) of the middle cerebral artery (MCA) territory remains unclear.
  • Understanding these associations is vital for predicting patient prognosis and guiding treatment strategies.

Purpose of the Study:

  • To investigate whether subacute lesion volume increase in the MCA territory is associated with neurological progression (NP) and clinical outcome (CO) in patients with SSI.
  • To determine if lesion volume expansion is an independent predictor of NP and poor CO.

Main Methods:

  • Diffusion-weighted MRI (DWI) was used to assess 77 patients with unilateral SSI in the MCA territory within 48 hours of stroke onset.
  • Follow-up DWI and MR angiography were performed within 7 days.
  • Neurological progression was defined as an increase in the NIHSS score by ≥2.
  • Clinical outcome was assessed using the modified Rankin Scale at 1 month.

Main Results:

  • A significant proportion of patients (54.5% by 50% increase, 66.2% by 30% increase) exhibited lesion volume increase.
  • Lesion volume increase was significantly associated with neurological progression (p=0.010 for 50%, p=0.027 for 30%) and poor clinical outcome (p=0.040 for 50%).
  • Multivariate analysis confirmed lesion volume increase as an independent predictor of NP (OR, 8.48) and NP as a strong predictor of poor CO (OR, 39.69).

Conclusions:

  • Subacute lesion volume growth in the MCA territory following SSI is closely related to neurological progression.
  • Neurological progression is a key predictor of subsequent poor clinical outcomes.
  • These findings highlight the prognostic value of monitoring infarct expansion in the subacute stroke phase.

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