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Updated: Apr 7, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Temporal Net Water Uptake Evolution and its Association with Functional Outcome in Acute Ischemic Stroke
Wiktor Olszewski1, Fabiano Cavalcante2, Laura van Poppel2
1From the Department of Biomedical Engineering and Physics (W.O., L.V.P., H.M., P. K.), Radiology and Nuclear Medicine (W.O., F.C., L.V.P., L.B., B.J.E., H.M., C.M., P.K.), Neurology (Y.R.), Amsterdam UMC - location University of Amsterdam, Amsterdam, Netherlands; Department of Neurology and Radiology (I.V.D.W.), Haaglanden Medical Center, the Hague, Netherlands; Department of Neurology (I. V.D.W.), Leiden University Medical Center, Leiden, Netherlands; KU Leuven, Department of Neurosciences (R.L.), Experimental Neurology; University Hospitals Leuven, Department of Neurology, Leuven, Belgium and Department of Neurology and Neurological Sciences (P.K.), Stanford University, Palo Alto, CA, United States. w.olszewski@amsterdamumc.nl.
Net Water Uptake (NWU) at 1 week after ischemic stroke, not earlier, predicts functional outcomes. Lesion evolution in the first week is key for potential secondary treatments.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Subacute lesion growth post-ischemic stroke correlates with poorer functional outcomes.
- Net Water Uptake (NWU), a CT-derived edema marker, assesses ischemic lesion severity.
- While pre-treatment NWU predicts outcomes, the impact of temporal NWU changes remains unclear.
Purpose of the Study:
- To investigate how Net Water Uptake (NWU) associations with functional outcomes change over the first week post-stroke.
- To determine the prognostic value of NWU at different time points and its temporal changes.
Main Methods:
- Analysis of 115 patients from the MRCLEAN NO-IV trial with anterior circulation large vessel occlusion treated with endovascular therapy.
- Utilized non-contrast CT scans at baseline, 24 hours, and 1 week for NWU measurement.
- Assessed 90-day functional outcomes via modified Rankin Scale (mRS), analyzing associations with NWU and NWU change (ΔNWU) using logistic regression.
Main Results:
- NWU at 1 week post-stroke, unlike baseline or 24-hour measurements, significantly predicted functional dependence (aOR 0.66 per 5% increase).
- Increased NWU from baseline to 1 week (ΔNWU) also correlated with functional dependence (aOR 0.66 per 5% increase).
- Median NWU increased from 4.3% at baseline to 15% at 1 week, with a median change of 10%.
Conclusions:
- One-week post-stroke NWU is a significant predictor of 90-day clinical outcomes.
- Lesion evolution continues throughout the first week, suggesting a potential window for secondary interventions.
- NWU dynamics may offer targets for therapies aimed at improving stroke recovery.
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