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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
MR perfusion lesions after TIA or minor stroke are associated with new infarction at 7 days
Jun Lee1, Manabu Inoue1, Michael Mlynash1
1From Yeungnam University Medical Center (J.L.), Daegu, South Korea; Department of Vascular Medicine (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Stanford Stroke Center (M.M., G.W.A.), Stanford University, CA; Division of Neurology (S.K.M.), University of British Columbia, Vancouver, Canada; Stroke Center Neurocenter of Southern Switzerland (C.W.C.), Ospedale Civico, Switzerland; California Pacific Medical Center (M.K.), San Francisco; and Toulouse Neuroimaging Center UMR 1214 (J.M.O.), Stroke Unit, Toulouse University Hospital, France.
Objective:
To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week.
Methods:
Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions.
Results:
Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3-5). Median delay from onset to baseline and follow-up MRI was 5 (2-10) hours and 6 (5-7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion.
Conclusions:
Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.
Insights
Acute perfusion-weighted imaging (PWI) lesions after transient ischemic attack (TIA) or minor stroke predict new brain infarctions (BI) within a week. These new BIs may stem from the initial ischemic injury progression.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Transient ischemic attack (TIA) and minor brain infarction (BI) require accurate prognostication.
- Perfusion-weighted imaging (PWI) can detect acute ischemic changes.
Purpose of the Study:
- To determine if acute PWI lesions predict new BI development within one week.
- To investigate the relationship between early PWI findings and subsequent infarction.
Main Methods:
- Prospective enrollment of TIA/BI patients without revascularization therapy.
- Baseline DWI/PWI and 1-week FLAIR/DWI MRI scans were performed.
- Blinded assessment of acute lesions and new infarctions on follow-up MRI.
Main Results:
- 38 out of 64 patients showed acute ischemic lesions on baseline DWI/PWI.
- Nine patients (14%) developed new BI on follow-up MRI.
- New BIs were associated with baseline PWI lesions, with most occurring in the same location.
Conclusions:
- Approximately 30% of acute focal PWI lesions after TIA are linked to new BI at one week.
- New brain infarctions may represent progression of the initial ischemic injury.
- PWI findings are valuable for predicting early infarct expansion after TIA/minor BI.
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