Interobserver reliability of a clinical classification of acute cerebral infarction.

This was a preliminary study to see whether patterns of vascular pathology correlated with a simple clinical classification of acute cerebral infarction. Thirty-two patients with acute, first-ever hemispheric cerebral infarction were prospectively studied clinically together with an extra- and transcranial Doppler ultrasound. All 14 patients with the triad of ipsilateral motor/sensory deficit, homonymous hemianopia and higher cortical dysfunction (Total Anterior Circulation Infarction,[TACI]) had occlusion of the symptomatic middle cerebral artery and/or internal carotid artery, or a severe middle cerebral artery stenosis. Three patients with lacunar infarction had no evidence of major vessel occlusion. Eleven of thirteen patients with Partial Anterior Circulation, Infarction (PACI) I(i.e. only one or two clinical features of the TACI triad) had patent symptomatic major vessels, with indirect evidence to suggest distal branch occlusion(s) of the middle cerebral artery in six. The remaining two PACI patients had major vessel occlusions. Two patients were not clinically classifiable, but both had significant vascular pathology on ultrasound. The findings of this preliminary study therefore suggest that a simple clinical classification was generally capable of predicting patterns of vascular pathology inpatients with acute cerebral infarction, which could have implications for the selection of patients for clinical trials of thrombolytic therapy.

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Diffusion kurtosis imaging and diffusion-weighted imaging-based classification of acute stroke lesions in the brain: A pilot study

10.21203/rs.3.rs-27738/v1 ◽

2020 ◽

Author(s):

Xin Liu ◽

Songsen Chen ◽

Fang Chen ◽

Lei Wang ◽

Khan Afsar ◽

...

Keyword(s):

Cerebral Infarction ◽

Acute Stroke ◽

Diffusion Weighted Imaging ◽

Tissue Injury ◽

Acute Cerebral Infarction ◽

Diffusion Kurtosis Imaging ◽

Type I ◽

Type Ii ◽

Diffusion Kurtosis

Abstract Background: We postulated that diffusion kurtosis imaging (DKI) could classify heterogeneous stroke lesions on diffusion-weighted imaging (DWI) and improve our understanding of the characteristics of tissue injury. We aimed to retrospectively study different DKI parameters in patients with acute stroke reported in the literature. Methods: We collected the DWI and DKI data of 41 patients (26 men, 15 women), including 86 cases of acute cerebral infarction in different brain regions. Of them, 20 patients had single infarction, whereas others had multiple infarctions. Acute cerebral infarction lesions were classified into two categories based on DKI and DWI parameters: type I, matched DKI and DWI parameters and type II, mismatched DKI and DWI parameters. Regions of interest (ROIs) were outlined within the most severely infarcted areas of each lesion according to each independent parametric map. In the control groups, same-sized ROIs were located in the corresponding region of the normal contralateral hemisphere. In both categories, DKI and DWI parameters followed a normal Gaussian distribution. We used the independent sample t-test to compare the differences in each group. Results: In type I cases, fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity, mean kurtosis (MK), and axial kurtosis (Ka) values were significantly different (P<0.05). In type II cases, only MK and Ka values were significantly different (P<0.05). Conclusions: DKI can provide more information on acute ischemic brain infarction and enrich our understanding of ischemic tissue injury. This DKI and DWI parameters-based classification of acute stroke lesions may confer a renewed understanding of infarction cores.

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