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From the Stanford Stroke Center, Department of Neurology and Neurological Sciences (Drs. Tong, Yenari, Albers, and O'Brien), and Department of Radiology, Section of Neuroradiology (Drs. Marks and Moseley), Stanford University Medical Center, Palo Alto, CA.
Address correspondence and reprint requests to Dr. David C. Tong, Stanford Stroke Center, 701 Welch Road, Suite 325B, Palo Alto, CA 94304.
Background: Diffusion-weighted (DWI) and perfusion-weighted (PWI) MRI are powerful new techniques for the assessment of acute cerebral ischemia. However, quantitative data comparing the severity of clinical neurologic deficit with the results of DWI or PWI in the earliest phases of stroke are scarce. Such information is vital if MRI is potentially to be used as an objective adjunctive measure of stroke severity and outcome.
Objective: The authors compared initial DWI and PWI lesion volumes with subsequent 24-hour neurologic deficit as determined by National Institutes of Health Stroke Scale (NIHSS) score in acute stroke patients. Initial DWI and PWI volumes were also compared with T2W MRI lesion volume at 1 week to assess the accuracy of these MRI techniques for the detection of acute cerebral ischemia.
Methods: Patients with stroke underwent MRI scanning within 6.5 hours of symptom onset. Lesion volumes on DWI and PWI were measured and compared with 24-hour NIHSS score. Initial DWI and PWI volumes were also compared with T2W lesion size at 1 week.
Results: There was a high correlation between 24-hour NIHSS score and lesion volume as determined by PWI (r = 0.96, p < 0.001) or DWI(r = 0.67, p = 0.03). A similar high correlation was seen between T2W stroke size at 7 days and initial DWI and PWI lesion size(r = 0.99, p < 0.00001).
Conclusions: Both DWI and PWI are highly correlated with severity of neurologic deficity by 24-hour NIHSS score. These findings may have substantial implications for the use of MRI scanning in the assessment and management of acute stroke patients.
Supported in part by NINDS grants 1R01NS34866-01A1, 1R01NS35959-01A1, and 1R01NS34088 and a grant from Janssen Pharmaceutica.
Received May 14, 1997. Accepted in final form November 20, 1997.
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