What ASPECTS Value Best Predicts the 100-mL Threshold on Diffusion Weighted Imaging? Study of 150 Patients with Middle Cerebral Artery Stroke

P75 Background and Purpose: Previous studies demonstrated that secondary ischemic lesions documented by diffusion-weighted imaging might be smaller than, larger than or similar to initial lesions that occur during ischemia. The purpose of this study was to investigate if the size of secondary lesions can be predicted. Methods: Twelve rats underwent 30 minutes of transient middle cerebral artery occlusion with the intraluminal suture method. Diffusion- and perfusion-weighted images were performed just before reperfusion, 90 minutes and 24 hours after reperfusion. The ischemic lesion size was calculated by tracing visual abnormalities on the apparent diffusion coefficient (ADC) maps. Cerebral blood flow index (CBF i ) ratio was calculated by dividing the ipsilateral CBF i by the contralateral CBF i . Based on difference between initial and secondary lesion volume, rats were assigned to reperfusion-benefit group (n=6) where secondary lesions were smaller than initial lesions (less than 85% of initial lesions) and reperfusion-nonbenefit group (n=6) where secondary lesions were similar to or larger than initial lesions (more than 85% of initial lesions). Results: At 90 minutes after reperfusion, the initial ischemic lesions almost disappeared in both groups. At 24 hours, secondary lesions were 54±11% (mean±SD) of the initial lesions in the reperfusion-benefit group and 100±14% of the initial lesions in the reperfusion-nonbenefit group (p<0.001). There was no difference in ADC values (47±2×10 -5 mm 2 /s vs 46±5×10 -5 mm 2 /s, p=0.7) and CBF i ratio (0.62±0.06 vs 0.67±0.04, p=0.2) between the two groups before reperfusion. However, the initial lesion volume was significantly smaller in the reperfusion-benefit group than in the reperfusion-nonbenefit group (125±54 mm 3 vs 195±36 mm 3 , p=0.037). Conclusions: Changes of ADC values and CBF before reperfusion are unable to predict if initial ischemic lesions will eventually shrink or not after reperfusion. Smaller size of initial lesions may suggest that secondary lesions will be smaller than initial lesions.

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Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke

Stroke ◽

10.1161/strokeaha.114.006694 ◽

2014 ◽

Vol 45 (12) ◽

pp. 3583-3588 ◽

Cited By ~ 22

Author(s):

Julian Schröder ◽

Bastian Cheng ◽

Martin Ebinger ◽

Martin Köhrmann ◽

Ona Wu ◽

...

Keyword(s):

Acute Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Diffusion Weighted Imaging ◽

Volume Estimation ◽

Lesion Volume ◽

Lesion Location ◽

Computed Tomographic ◽

Stroke Lesion ◽

Middle Cerebral Artery Stroke

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Diffusion-weighted MRI of middle cerebral artery stroke in a newborn

Pediatric Radiology ◽

10.1007/s002470100442 ◽

2001 ◽

Vol 31 (5) ◽

pp. 374-376 ◽

Cited By ~ 5

Author(s):

Karl-Olof Lövblad ◽

Kerstin Ruoss ◽

Raphael Guzman ◽

Gerhard Schroth ◽

Christoph Fusch

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Diffusion Weighted Mri ◽

Diffusion Weighted ◽

Middle Cerebral Artery Stroke

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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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011602 ◽

2016 ◽

Vol 9 (2) ◽

pp. 127-130 ◽

Cited By ~ 5

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.

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Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion‐weighted imaging lesions

European Journal of Neurology ◽

10.1111/ene.14330 ◽

2020 ◽

Vol 27 (10) ◽

pp. 1988-1995

Author(s):

C. Sabben ◽

J. P. Desilles ◽

F. Charbonneau ◽

J. Savatovsky ◽

E. Morvan ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Endovascular Therapy ◽

Diffusion Weighted Imaging ◽

Young Patients ◽

Middle Cerebral Artery Infarction ◽

Diffusion Weighted ◽

Large Diffusion

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Sustained diffusion reversal with in-bore reperfusion in monkey stroke models: Confirmed by prospective magnetic resonance imaging

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x16659302 ◽

2016 ◽

Vol 37 (6) ◽

pp. 2002-2012 ◽

Cited By ~ 6

Author(s):

Kyung Sik Yi ◽

Chi-Hoon Choi ◽

Sang-Rae Lee ◽

Hong Jun Lee ◽

Youngjeon Lee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Diffusion Weighted Imaging ◽

Artery Occlusion ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Cerebral Artery Occlusion

Although early diffusion lesion reversal after recanalization treatment of acute ischaemic stroke has been observed in clinical settings, the reversibility of lesions observed by diffusion-weighted imaging remains controversial. Here, we present consistent observations of sustained diffusion lesion reversal after transient middle cerebral artery occlusion in a monkey stroke model. Seven rhesus macaques were subjected to endovascular transient middle cerebral artery occlusion with in-bore reperfusion confirmed by repeated prospective diffusion-weighted imaging. Early diffusion lesion reversal was defined as lesion reversal at 3 h after reperfusion. Sustained diffusion lesion reversal was defined as the difference between the ADC-derived pre-reperfusion maximal ischemic lesion volume (ADCD-P Match) and the lesion on 4-week follow-up FLAIR magnetic resonance imaging. Diffusion lesions were spatiotemporally assessed using a 3-D voxel-based quantitative technique. The ADCD-P Match was 9.7 ± 6.0% (mean ± SD) and the final infarct was 1.2–6.0% of the volume of the ipsilateral hemisphere. Early diffusion lesion reversal and sustained diffusion lesion reversal were observed in all seven animals, and the calculated percentages compared with their ADCD-P Match ranged from 8.3 to 51.9% (mean ± SD, 26.9 ± 15.3%) and 41.7–77.8% (mean ± SD, 65.4 ± 12.2%), respectively. Substantial sustained diffusion lesion reversal and early reversal were observed in all animals in this monkey model of transient focal cerebral ischaemia.

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