Diffusion-Weighted Imaging Volume as the Best Predictor of the Diffusion-Perfusion Mismatch in Acute Stroke Patients within 8 Hours of Onset

2014 ◽  
Vol 25 (2) ◽  
pp. 217-225 ◽  
Author(s):  
Junya Aoki ◽  
Yohei Tateishi ◽  
Christopher L. Cummings ◽  
Esteban Cheng-Ching ◽  
Paul Ruggieri ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Diffusion Weighted Imaging ◽  
Stroke Patients ◽  
Diffusion Weighted

Higher rate of cortical infarcts shown in acute stroke patients using high resolution diffusion weighted imaging

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S406-S406
Author(s):  
Karima Benameur ◽  
Julie Bykowski ◽  
Marie Luby ◽  
Naomi Lewin ◽  
Steven Warach ◽  
...  
Keyword(s):  
High Resolution ◽  
Acute Stroke ◽  
Diffusion Weighted Imaging ◽  
Stroke Patients ◽  
Diffusion Weighted

scholarly journals Magnetic Resonance Imaging of Acute Stroke

1998 ◽  
Vol 18 (6) ◽  
pp. 583-609 ◽  
Author(s):  
Alison E. Baird ◽  
Steven Warach
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Stroke ◽  
Perfusion Imaging ◽  
Diffusion Weighted Imaging ◽  
Mr Angiography ◽  
Great Promise ◽  
Proton Density ◽  
Diffusion Weighted ◽  
Cerebral Ischemic

In the investigation of ischemic stroke, conventional structural magnetic resonance (MR) techniques (e.g., T1-weighted imaging, T2-weighted imaging, and proton density-weighted imaging) are valuable for the assessment of infarct extent and location beyond the first 12 to 24 hours after onset, and can be combined with MR angiography to noninvasively assess the intracranial and extracranial vasculature. However, during the critical first 6 to 12 hours, the probable period of greatest therapeutic opportunity, these methods do not adequately assess the extent and severity of ischemia. Recent developments in functional MR imaging are showing great promise for the detection of developing focal cerebral ischemic lesions within the first hours. These include (1) diffusion-weighted imaging, which provides physiologic information about the self-diffusion of water, thereby detecting one of the first elements in the pathophysiologic cascade leading to ischemic injury; and (2) perfusion imaging. The detection of acute intraparenchymal hemorrhagic stroke by susceptibility weighted MR has also been reported. In combination with MR angiography, these methods may allow the detection of the site, extent, mechanism, and tissue viability of acute stroke lesions in one imaging study. Imaging of cerebral metabolites with MR spectroscopy along with diffusion-weighted imaging and perfusion imaging may also provide new insights into ischemic stroke pathophysiology. In light of these advances in structural and functional MR, their potential uses in the study of the cerebral ischemic pathophysiology and in clinical practice are described, along with their advantages and limitations.

scholarly journals In Acute Stroke, Can CT Perfusion-Derived Cerebral Blood Volume Maps Substitute for Diffusion-Weighted Imaging in Identifying the Ischemic Core?

PLoS ONE ◽  
2015 ◽  
Vol 10 (7) ◽  
pp. e0133566 ◽  
Author(s):  
William A. Copen ◽  
Livia T. Morais ◽  
Ona Wu ◽  
Lee H. Schwamm ◽  
Pamela W. Schaefer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Blood Volume ◽  
Diffusion Weighted Imaging ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Diffusion Weighted ◽  
Ischemic Core

Clinical diffusion mismatch better discriminates infarct growth than mean transit time–diffusion weighted imaging mismatch in patients with middle cerebral artery–M1 occlusion and limited infarct core

2016 ◽  
Vol 9 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Raul G Nogueira ◽  
Andre Kemmling ◽  
Leticia M Souza ◽  
Seyedmehdi Payabvash ◽  
Joshua A Hirsch ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Mean Transit Time ◽  
Stroke Patients ◽  
Infarct Core ◽  
Nihss Score ◽  
Diffusion Weighted ◽  
Small Infarct

Background and purposeOur purpose was to compare clinical diffusion mismatch (CDM) and mean transit time (MTT)-diffusion mismatch as predictors of infarct growth in patients with proximal middle cerebral artery (MCA) occlusion and small infarct core on presentation.MethodsRetrospective analysis of consecutive stroke patients with: (1) MCA-M1 occlusion; (2) MRI performed ≤10 h from symptoms onset; and (3) baseline MRI-diffusion weighted imaging (DWI) volume ≤25 mL. Definitions included: CDM=baseline National Institutes of Health Stroke Scale (NIHSS) score ≥8 and DWI volume ≤25 mL; MTT-DWI mismatch=visually assessed unthresholded MTT lesion ((MTT-DWI))/DWI) ≥20% and ≥10 mL larger than the DWI lesion; and significant infarct growth (>20% (≥5 mL) increase in infarct volume on follow-up). Uni-/multivariate analyses were performed to define the predictors of infarct growth.Results63 stroke patients with MCA-M1 occlusions and MRI within 10 h of onset were evaluated. 20 patients were excluded on the basis of DWI volume >25 mL leaving 43 patients (mean age 75.8 years; median NIHSS=13) in the study cohort. On univariate analysis, larger admission DWI volume (p<0.0001), baseline NIHSS score ≥8 (p=0.001), lack of IV and/or endovascular treatment (p=0.021), glucose levels >125 mg/dL (p=0.024), poor CT angiography collaterals (p=0.046), and lower admission Alberta Stroke Program Early CT score (ASPECTS) (p=0.049) predicted infarct growth. Baseline NIHSS score ≥8 was the only independent predictor of stroke growth in the multivariate analysis (p=0.001). All patients had MTT-DWI mismatch >20%. There was no significant association between the amount of MTT-DWI mismatch and infarct growth (p=0.33).ConclusionsCDM is the most powerful predictor of infarct growth in patients with MCA-M1 occlusion and small infarct core. Most of these patients will have a significant oligemic MTT lesion regardless of admission NIHSS score.

scholarly journals Role of Diffusion Weighted Imaging in Enhancing MR Imaging in Recent Is-chemic Stroke Patients

2020 ◽  
Vol 35 (2) ◽  
pp. 104-115
Author(s):  
Hajer A. Alfadeel
Keyword(s):  
Acute Stroke ◽  
Spin Echo ◽  
Haemorrhagic Stroke ◽  
P Value ◽  
Consecutive Series ◽  
Stroke Patients ◽  
First Line ◽  
Diffusion Weighted ◽  
Significant Difference

Stroke is a common cause of admission to hospitals, and imaging in acute stroke is necessary to differentiate ischemic from haemorrhagic stroke and to exclude other diagnoses. This study aimed to evaluate the role of diffusion-weighted magnetic resonance imaging (DW MRI) in the diagnosis of recent cerebral ischemic infarction in a consecutive series of patients with symptoms of acute stroke and its feasibility as first-line imaging for those patients. We report our results with DWI and apparent diffusion coefficient (ADC) mapping comparing the sensitivity of DWI with that of conventional T2 weighted and fluid-attenuated inversion recovery (FLAIR) MRI. A Prospective audit of 87 patients with clinically suspected recent stroke referred for imaging over a consecutive 20-week period was done. The data collected included patient age, time from onset of symptoms, and clinical presentation. DWI echo planar, FLAIR, and turbo spin-echo T2-weighted MRI were performed, and ADC maps were generated. Conventional MR images were assessed before DW images. DWI was considered positive for the diagnosis of new arterial stroke whenever hyperintensities with reduced ADC values were observed, and the site of infarct detected on the images was included in patients’ data. The results were 47 patients had a final diagnosis of recent ischemic cerebral infarct. With DWI, 98% of the ischemic lesions were detected, whereas with FLAIR, only 70% were detected, and with T2-weighted images, 66% of lesions were found. There was a significant difference between the results of ischemic infarcts’ detection on DWI and T2-w/FLAIR in relation to time from onset (P value = .012). In this study, I was able to image 68% (60 of 87) of the referred suspected stroke patients with DW MRI within 48 hours and 39 patients (45%) within 24 hours of the onset of symptoms. DW MRI showed high sensitivity and superiority over conventional T2 and FLAIR imaging for the detection of acute ischemic lesions in stroke patients; it also proved quite feasible as a first-line of neuroimaging.  

Abstract TP188: Migraine History is the Only Predictor of Negative Diffusion Weighted Imaging in Patients Treated with IV-Thrombolytic

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jussie Lima ◽  
Tapan Mehta ◽  
Neil Datta ◽  
Ekaterina Bakradze ◽  
Dawn Beland ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Statistical Significance ◽  
Lower Probability ◽  
Stroke Patients ◽  
Retrospective Case ◽  
Diffusion Weighted ◽  
Complication Risk ◽  
Suspected Stroke ◽  
Iv Tpa ◽  
Negative Diffusion

Background: Migraine, seizures, and psychiatric disorders are frequently reported as “stroke mimics” in patients with negative diffusion weighted imaging (DWI) after IV-tPA. We sought to determine predictors of negative DWI in suspected stroke patients treated with IV-tPA. Methods: A retrospective case-control study encompassing all acute stroke patients treated with IV-tPA (at our hospital or "dripped and shipped") from January 2013-December 2014 was conducted. A total of 275 patients were identified with 47 negative DWI cases and 228 positive DWI controls. Variables including demographic factors, stroke characteristics, and clinical comorbidities were analyzed for statistical significance. A multivariate logistic regression was performed (SPSS-24) to identify predictors of negative DWI. Results: Approximately 17% of patients had negative DWI after IV-tPA. Compared to controls, migraine history independently predicted negative DWI (OR 5.0 95% CI 1.03-24.6, p=0.046). Increasing age (OR 0.97 95% CI 0.94-0.99, p=0.02) and atrial fibrillation (OR 0.25 95% CI 0.08-0.77 p=0.01) predicted lower probability of negative DWI. Gender, admission NIHSS, treatment location, pre-admission modified Rankin scale, diabetes mellitus, hypertension, hyperlipidemia, symptom side, seizure history, and psychiatric history did not predict negative DWI status. Conclusion: In our study, only pre-existing migraine history independently predicted negative DWI after IV-tPA treatment in suspected stroke patients. Although helpful in acute evaluation, this should not preclude treatment with IV-tPA considering the outcomes of missed strokes and low complication risk of IV-tpa in these patients.

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