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Apparent diffusion coefficient threshold for delineation of ischemic core.

Archana Purushotham1, Bruce C V Campbell, Matus Straka

  • 1Department of Neurology and Neurological Sciences, the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, National Center for Biological Sciences, Bangalore, India.

International Journal of Stroke : Official Journal of the International Stroke Society
|June 28, 2013
PubMed
Summary
This summary is machine-generated.

Automated software can now rapidly identify the ischemic core in stroke patients using an apparent diffusion coefficient threshold. This improves acute stroke intervention selection by providing objective and quick infarct core estimation.

Keywords:
apparent diffusion coefficientdiffusion MRIdiffusion-perfusion imagingischemic coreischemic strokeneuroimaging of acute stroke

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Area of Science:

  • Neuroimaging
  • Radiology
  • Stroke Imaging

Background:

  • Accurate infarct core estimation on diffusion-weighted MRI is crucial for acute stroke intervention selection.
  • Manual delineation of restricted diffusion lesions is time-consuming and subjective.
  • Automated methods are needed for rapid and objective ischemic core identification.

Purpose of the Study:

  • To determine apparent diffusion coefficient (ADC) criteria for automated ischemic core identification.
  • To develop criteria for a fully automated software solution for infarct core segmentation.

Main Methods:

  • Analysis of diffusion-weighted MRI data from the DEFUSE study.
  • Manual delineation of restricted diffusion and 30-day infarct lesions.
  • Voxel-based receiver operating characteristics analysis to determine the optimal ADC threshold.

Main Results:

  • An apparent diffusion coefficient threshold of ≤ 620 × 10(-6) mm(2)/s identified the ischemic core with 69% sensitivity and 78% specificity.
  • Core voxels exhibited significantly lower ADC values than noncore voxels (P < 0.0001).
  • Mean ischemic core volume was 18 ml (± 22 ml).

Conclusions:

  • An absolute apparent diffusion coefficient threshold can reliably identify the ischemic core.
  • This threshold is suitable for implementation in image analysis software for automated segmentation.
  • Automated segmentation facilitates rapid and objective infarct core estimation in acute stroke.