Prediction of Subacute Infarct Size in Acute Middle Cerebral Artery Stroke: Comparison of Perfusion-weighted Imaging and Apparent Diffusion Coefficient Maps

Radiology ◽  
2012 ◽  
Vol 265 (2) ◽  
pp. 511-517 ◽  
Author(s):  
Aurélie Drier ◽  
Thomas Tourdias ◽  
Yohan Attal ◽  
Igor Sibon ◽  
Gurkan Mutlu ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perfusion Weighted Imaging ◽  
Apparent Diffusion ◽  
Apparent Diffusion Coefficient Maps ◽  
Middle Cerebral Artery Stroke

scholarly journals Infarct Volume Before Hemicraniectomy in Large Middle Cerebral Artery Infarcts Poorly Predicts Catastrophic Outcome

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2404-2410
Author(s):  
Barbara Casolla ◽  
Gregory Kuchcinski ◽  
Maéva Kyheng ◽  
Riyad Hanafi ◽  
Jean-Paul Lejeune ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Apparent Diffusion

Background and Purpose: Infarct volumes predict malignant infarcts in patients undergoing decompressive hemicraniectomy (DH) for large middle cerebral artery territory infarcts. The aim of the study was to determine the optimal magnetic resonance imaging infarct volume threshold that predicts a catastrophic outcome at 1 year (modified Rankin Scale score of 5 or death). Methods: We included consecutive patients who underwent DH for large middle cerebral artery infarcts. We analyzed infarct volumes before DH with semi-automated methods on b1000 diffusion-weighted imaging sequences and apparent diffusion coefficient maps. We studied infarct volume thresholds for prediction of catastrophic outcomes, and analyzed sensitivity, specificity, and the area under the curve, a value ≥0.70 indicating an acceptable prediction. Results: Of 173 patients (109 men, 63%; median age 53 years), 42 (24.3%) had catastrophic outcomes. Magnetic resonance imaging b1000 diffusion-weighted imaging and apparent diffusion coefficient infarct volumes were associated to the occurrence of 1-year catastrophic outcome (adjusted odds ratio, 9.17 [95% CI, 2.00–42.04] and odds ratio, 4.18 [95% CI, 1.33–13.19], respectively, per 1 log increase). The optimal volume cutoff of were 211 mL on b1000 diffusion-weighted imaging and 181 mL on apparent diffusion coefficient maps. The 2 methods showed similar sensitivities and specificities and overlapping area under the curve of 0.64 (95% CI, 0.54–0.74). Conclusions: In patients with large middle cerebral artery infarcts, optimal magnetic resonance imaging infarct volume thresholds showed poor accuracy and low specificity to predict 1-year catastrophic outcome, with different b1000 diffusion-weighted imaging and apparent diffusion coefficient thresholds. In the setting of DH, optimal infarct volumes alone should not be used to deny DH, irrespectively of the method used.

scholarly journals The influence of gender on ‘tissue at risk’ in acute stroke: A diffusion-weighted magnetic resonance imaging study in a rat model of focal cerebral ischaemia

2015 ◽  
Vol 36 (2) ◽  
pp. 381-386 ◽  
Author(s):  
Tracey A Baskerville ◽  
I Mhairi Macrae ◽  
William M Holmes ◽  
Christopher McCabe
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Ischaemic Injury ◽  
Diffusion Weighted ◽  
Apparent Diffusion ◽  
Cerebral Artery Occlusion

This is the first study to assess the influence of sex on the evolution of ischaemic injury and penumbra. Permanent middle cerebral artery occlusion was induced in male (n = 9) and female (n = 10) Sprague-Dawley rats. Diffusion-weighted imaging was acquired over 4 h and infarct determined from T2 images at 24 h post-permanent middle cerebral artery occlusion. Penumbra was determined retrospectively from serial apparent diffusion coefficient lesions and T2-defined infarct. Apparent diffusion coefficient lesion volume was significantly smaller in females from 0.5 to 4 h post permanent middle cerebral artery occlusion as was infarct volume. Penumbral volume, and its loss over time, was not significantly different despite the sex difference in acute and final lesion volumes.

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