Diffusion Kurtosis Shows a Smaller Ischemic Core Versus Diffusion-Weighted MR in Early or Subacute Post-Thrombectomy...

Area of Science:

• Neuroimaging
• Radiology
• Stroke Research

Background:

• Diffusion-weighted imaging (DWI) is standard for acute stroke, but may overestimate injury due to Gaussian diffusion assumptions.
• Diffusion kurtosis imaging (DKI) accounts for non-Gaussian water diffusion, potentially offering more accurate tissue characterization.
• Few studies compare DWI and DKI in both ultra-early (3-h) and subacute (24-72 h) postreperfusion windows.

Purpose of the Study:

• To compare the accuracy of DWI and DKI in measuring ischemic core evolution after reperfusion therapy.
• To evaluate the utility of DKI in characterizing tissue microstructure changes in acute stroke.

Main Methods:

• Fifty-two large vessel occlusion stroke patients underwent endovascular thrombectomy.
• DWI and DKI were performed at <3 h and 24-72 h postreperfusion.
• Lesion volumes were segmented, and diffusion metrics (ADC, MK) were analyzed.

Main Results:

• DKI lesion volumes were significantly smaller than DWI at both time points (3 h and 24-72 h).
• Mismatch regions (DKI(+ve)-DWI(-ve)) showed less severe injury (higher ADC, lower MK).
• Lesion reversal percentages were similar between DWI and DKI.

Conclusions:

• DKI provides additional information beyond DWI for assessing irreversibly injured tissue in acute stroke.
• DKI's smaller lesion volumes and tissue microstructure insights may improve ischemic core assessment.
• DKI could potentially guide treatment decisions more effectively after reperfusion therapy.