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Measurement of infarct size using MRI predicts prognosis in middle cerebral artery infarction
D E Saunders1, A G Clifton, M M Brown
1Division of Clinical Neuroscience, St George's Hospital Medical School, London, UK.
Background And Purpose:
An accurate measure of the severity of ischemic insult and the resulting prognosis is needed to assess the effectiveness of new treatments for acute stroke. We studied the reproducibility and accuracy of measurements of infarct volume with MRI and correlated the measurements with outcome.
Methods:
Infarct volume was measured on T2-weighted images with the Analyze image analysis software. This technique was found to be highly accurate and reproducible.
Results:
Measurements of infarct volume were found to be highly accurate and reproducible. Twenty-one patients (mean age, 66.5 years; range, 28 to 90 years) with cortical middle cerebral artery territory infarcts in whom adequate data could be obtained were studied within 72 hours from onset (mean delay to MRI, 27.5 hours; range, 5 to 72 hours). The Scandinavian Stroke Scale was used to calculate a prognostic score, and clinical outcome was assessed at 3 months. Infarct volume was found to significantly predict outcome. Mean infarct volume in the independent patients was 35.7 +/- 29.7 cm3 compared with 88.3 +/- 71.3 cm3 in dependent patients and 166.5 +/- 65.9 cm3 in dead patients (F = 10.52, P < .001). Patients with an initial infarct volume less than 80 cm3 were found to have a better outcome than those with larger infarct volumes. Secondary hemorrhage visible on MRI also predicted a poor outcome. In contrast, the Scandinavian Stroke Scale did not significantly predict outcome.
Conclusions:
The results demonstrate that measurement of the size of middle cerebral artery infarction with MRI is a useful tool in assessing prognosis and will have a valuable role in assessing new therapeutic agents.
Insights
Magnetic resonance imaging (MRI) accurately measures infarct volume in acute stroke, predicting patient outcomes. Larger infarct volumes correlate with poorer prognosis, highlighting MRI
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Accurate assessment of ischemic stroke severity and prognosis is crucial for evaluating new treatments.
- Magnetic resonance imaging (MRI) offers a potential method for measuring infarct volume and predicting outcomes.
Purpose of the Study:
- To evaluate the reproducibility and accuracy of MRI measurements of infarct volume in acute stroke.
- To correlate infarct volume measurements with patient outcomes.
Main Methods:
- Infarct volume was measured using T2-weighted MRI images and Analyze image analysis software.
- Twenty-one patients with middle cerebral artery territory infarcts were studied within 72 hours of stroke onset.
- Clinical outcome was assessed at 3 months, and the Scandinavian Stroke Scale was used for prognostic scoring.
Main Results:
- MRI measurement of infarct volume demonstrated high accuracy and reproducibility.
- Infarct volume significantly predicted patient outcome (P < .001).
- Mean infarct volumes were 35.7 cm3 (independent), 88.3 cm3 (dependent), and 166.5 cm3 (deceased). Patients with infarcts <80 cm3 had better outcomes.
- Secondary hemorrhage on MRI also predicted poor outcomes, while the Scandinavian Stroke Scale did not.
Conclusions:
- MRI measurement of middle cerebral artery infarct size is a valuable tool for prognosis assessment in acute stroke.
- This technique will be instrumental in evaluating the efficacy of novel therapeutic agents for stroke.