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Prediction of final infarct volume on subacute MRI by quantifying cerebral edema in ischemic stroke
Aaryani Tipirneni-Sajja1,2,3, Soren Christensen1, Matus Straka1
11 Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
Abstract:
Final infarct volume in stroke trials is assessed on images obtained between 30 and 90 days after stroke onset. Imaging at such delayed timepoints is problematic because patients may be lost to follow-up or die before the scan. Obtaining an early assessment of infarct volume on subacute scans avoids these limitations; however, it overestimates true infarct volume because of edema. The aim of this study was to develop a novel approach to quantify edema so that final infarct volumes can be approximated on subacute scans. We analyzed data from 20 stroke patients (median age, 75 years) who had baseline, subacute (fu5d) and late (fu90d) MRI scans. Edema displaces CSF from sulci and ventricles; therefore, edema volume was estimated as change in CSF volume between baseline and spatially coregistered fu5d ADC maps. The median (interquartile range, IQR) estimated edema volume was 13.3 (7.5-37.7) mL. The fu5d lesion volumes correlated well with fu90d infarct volumes with slope: 1.24. With edema correction, fu5d infarct volumes are in close agreement, slope: 0.97 and strongly correlated with actual fu90d volumes. The median (IQR) difference between actual and predicted infarct volumes was 0.1 (-3.0-5.7) mL. In summary, this novel technique for estimation of edema allows final infarct volume to be predicted from subacute MRI.
Insights
Predicting final stroke infarct volume from early MRI scans is now possible. A new method accurately quantifies edema, allowing reliable estimation of infarct size on subacute (early) images, overcoming limitations of delayed imaging.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Final infarct volume is crucial for stroke trial assessment but delayed imaging (30-90 days) poses challenges like patient loss.
- Subacute imaging (early) can predict final infarct volume but is complicated by edema, which artificially inflates lesion size.
Purpose of the Study:
- To develop and validate a novel method for quantifying edema on subacute MRI scans.
- To enable accurate prediction of final infarct volume using early, subacute imaging data.
Main Methods:
- Analyzed MRI scans (baseline, subacute, late) from 20 stroke patients.
- Estimated edema volume by measuring changes in cerebrospinal fluid (CSF) volume between baseline and subacute scans.
- Used spatially coregistered apparent diffusion coefficient (ADC) maps for edema quantification.
Main Results:
- Median estimated edema volume was 13.3 mL.
- Uncorrected subacute lesion volumes showed good correlation with final infarct volumes (slope: 1.24).
- Edema-corrected subacute volumes closely agreed with final infarct volumes (slope: 0.97), with a median difference of 0.1 mL.
Conclusions:
- A novel technique effectively estimates edema volume from subacute MRI.
- This method allows for accurate prediction of final infarct volume using early, subacute scans.
- The approach overcomes limitations of delayed imaging in stroke trials, improving patient outcome assessment.
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