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Updated: Jun 1, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Effect of baseline magnetic resonance imaging (MRI) apparent diffusion coefficient lesion volume on functional
Li Ma1, Pei-yi Gao, Qing-mao Hu
1Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China.
Objective:
We explored the relationship between predicted infarct core, predicted ischemic penumbras and predicted final infarct volumes obtained though apparent diffusion coefficient (ADC)-based method, as well as other clinical variables, and functional outcome.
Methods:
Patients with acute cerebral ischemic stroke were retrospectively recruited. The National Institutes of Health Stroke Scale score was evaluated at baseline and the modified Rankin Scale (mRS) at day 90. Favorable outcome was defined as an mRS score of 0 to 2, and unfavorable outcome as 3 to 6. Multimodal stroke magnetic resonance imaging was carried out at presentation. The volumes of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) were measured using the regions of interest (ROI) method. The volumes of predicted infarct core, predicted ischemic penumbra and predicted final infarct were obtained by an automated image analysis system based on baseline ADC maps. The association between baseline magnetic resonance imaging volumes, baseline clinical variables, and functional outcome was statistically analyzed.
Results:
The study included 30 males and 20 females (mean±SD age, 56±10 years). Baseline DWI, PWI and PWI-DWI mismatch volumes were not correlated with day-90 mRS (P>0.05). Predicted infarct core, predicted ischemic penumbra and predicted final infarct through ADC-based method were all correlated with day-90 mRS (P<0.05). A better outcome was associated with a smaller predicted volume. Low baseline National Institutes of Health Stroke Scale and recanalization also demonstrated a trend toward a favorable outcome. Receiver operating characteristic analysis showed that the area under the curve of predicted final infarct volume and recanalization were higher with statistical significance (P<0.001).
Discussion:
Predicted volumes obtained from ADC-based methods, especially predicted final infarct volume, as well as baseline National Institutes of Health Stroke Scale and recanalization may have effect on functional outcome in acute ischemic stroke.
Insights
Apparent diffusion coefficient (ADC)-based methods accurately predict final infarct volume and functional outcomes in acute ischemic stroke patients. Smaller predicted infarct volumes correlate with better outcomes, highlighting the importance of these imaging techniques for stroke management.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke is a leading cause of long-term disability.
- Accurate prediction of infarct volume and patient outcomes is crucial for effective treatment.
- Current methods for infarct volume estimation have limitations.
Purpose of the Study:
- To investigate the relationship between predicted infarct volumes derived from apparent diffusion coefficient (ADC)-based methods and functional outcomes in acute ischemic stroke patients.
- To compare the predictive value of ADC-based volumes with other clinical variables and traditional imaging metrics.
Main Methods:
- Retrospective analysis of acute ischemic stroke patients undergoing multimodal stroke MRI.
- Measurement of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) volumes.
- Automated image analysis using an ADC-based method to determine predicted infarct core, penumbra, and final infarct volumes.
- Statistical analysis correlating imaging volumes and clinical variables with 90-day functional outcomes (modified Rankin Scale).
Main Results:
- ADC-based predicted infarct core, penumbra, and final infarct volumes were significantly correlated with 90-day functional outcomes (mRS).
- Smaller predicted infarct volumes were associated with more favorable functional outcomes.
- Baseline DWI, PWI, and PWI-DWI mismatch volumes did not correlate with functional outcomes.
- Predicted final infarct volume and recanalization showed high predictive accuracy (AUC > 0.001).
Conclusions:
- ADC-based methods, particularly for predicting final infarct volume, are valuable tools for assessing functional outcomes in acute ischemic stroke.
- Baseline National Institutes of Health Stroke Scale score and recanalization status also influence functional outcomes.
- These findings support the use of ADC-based imaging in stroke prognostication and treatment planning.
