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From the Departments of Neurology (Drs. Barber, Darby, Gerraty, and Davis) and Radiology (Drs. Desmond, Yang, and Tress), The Royal Melbourne Hospital; and the Departments of Medicine (Dr. Donnan) and Public Health and Community Medicine (D. Jolley), University of Melbourne, Australia.
Address correspondence and reprint requests to Prof. Stephen Davis, Director of Neurology, The Royal Melbourne Hospital, Parkville, Vic 3050, Australia.
Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffusion-weighted imaging (DWI) in predicting stroke evolution and outcome in 18 patients with acute hemispheric infarction.
Methods: Patients were studied within 24 hours (mean, 12.2 hours), subacutely(mean, 4.7 days), and at outcome (mean, 84 days). Comparisons were made between infarction volumes as measured on perfusion imaging (PI) and isotropic DWI maps, clinical assessment scales (Canadian Neurological Scale, Barthel Index, and Rankin Scale), and final infarct volume (T2-weighted MRI).
Results: Acute PI lesion volumes correlated with acute neurologic state, clinical outcome, and final infarct volume. Acute DWI lesions correlated less robustly with acute neurologic state, but correlated well with clinical outcome and final infarct volume. Three of six possible patterns of abnormalities were seen: PI lesion larger than DWI lesion (65%), PI lesion smaller than DWI lesion (12%), and DWI lesion but no PI lesion (23%). A pattern of a PI lesion larger than the DWI lesion predicted DWI expansion into surrounding hypoperfused tissue (p < 0.05). In the other two patterns, DWI lesions did not enlarge, suggesting that no significant increase in ischemic lesion size occurs in the absence of a larger perfusion deficit.
Conclusions: Combined early PI and DWI can define different acute infarct patterns, which may allow the selection of rational therapeutic strategies based on the presence or absence of potentially salvageable ischemic tissue.
Supported by the National Health and Medical Research Council, the National Stroke Foundation, and the Neurological Foundation of New Zealand, VJ Chapman Research Fellowship (P.A.B.).
Received December 31, 1997. Accepted in final form March 27, 1998.
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K. W. Muir Heterogeneity of Stroke Pathophysiology and Neuroprotective Clinical Trial Design Stroke, June 1, 2002; 33(6): 1545 - 1550. [Abstract] [Full Text] [PDF]
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A. E. Hillis, R. J. Wityk, P. B. Barker, N. J. Beauchamp, P. Gailloud, K. Murphy, O. Cooper, and E. J. Metter Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion Brain, May 1, 2002; 125(5): 1094 - 1104. [Abstract] [Full Text] [PDF]
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J. N. Fink, M. H. Selim, S. Kumar, B. Silver, I. Linfante, L. R. Caplan, and G. Schlaug Is the Association of National Institutes of Health Stroke Scale Scores and Acute Magnetic Resonance Imaging Stroke Volume Equal for Patients With Right- and Left-Hemisphere Ischemic Stroke? Stroke, April 1, 2002; 33(4): 954 - 958. [Abstract] [Full Text] [PDF]
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C. S. Kidwell, J. L. Saver, J. Mattiello, S. Warach, D. S. Liebeskind, S. Starkman, P. M. Vespa, J. P. Villablanca, N. A. Martin, J. Frazee, et al. Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage Neurology, November 13, 2001; 57(9): 1611 - 1617. [Abstract] [Full Text] [PDF]
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C. Oppenheim, C. Grandin, Y. Samson, A. Smith, T. Duprez, C. Marsault, and G. Cosnard Is There an Apparent Diffusion Coefficient Threshold in Predicting Tissue Viability in Hyperacute Stroke? Stroke, November 1, 2001; 32(11): 2486 - 2491. [Abstract] [Full Text] [PDF]
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V. N. Thijs, A. Adami, T. Neumann-Haefelin, M. E. Moseley, M. P. Marks, and G. W. Albers Relationship between severity of MR perfusion deficit and DWI lesion evolution Neurology, October 9, 2001; 57(7): 1205 - 1211. [Abstract] [Full Text] [PDF]
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W. A. Copen, L. H. Schwamm, R. G. Gonzalez, O. Wu, C. B. Harmath, P. W. Schaefer, W. J. Koroshetz, and A. G. Sorensen Ischemic Stroke: Effects of Etiology and Patient Age on the Time Course of the Core Apparent Diffusion Coefficient Radiology, October 1, 2001; 221(1): 27 - 34. [Abstract] [Full Text] [PDF]
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S. Warach New imaging strategies for patient selection for thrombolytic and neuroprotective therapies Neurology, September 1, 2001; 57(90002): S48 - 52. [Abstract] [Full Text]
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G. W. Albers Advances in intravenous thrombolytic therapy for treatment of acute stroke Neurology, September 1, 2001; 57(90002): S77 - 81. [Abstract] [Full Text]
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P. M. Desmond, A. C. Lovell, A. A. Rawlinson, M. W. Parsons, P. A. Barber, Q. Yang, T. Li, D. G. Darby, R. P. Gerraty, S. M. Davis, et al. The Value of Apparent Diffusion Coefficient Maps in Early Cerebral Ischemia AJNR Am. J. Neuroradiol., August 1, 2001; 22(7): 1260 - 1267. [Abstract] [Full Text] [PDF]
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R. P. Gerraty, M. W. Parsons, P. Alan Barber, D. G. Darby, and S. M. Davis The Volume of Lacunes Stroke, August 1, 2001; 32(8): 1937 - 1938. [Full Text] [PDF]
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M. W. Parsons, Q. Yang, P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke : Relative Cerebral Blood Flow Most Accurately Identifies Tissue Destined to Infarct Stroke, July 1, 2001; 32(7): 1581 - 1587. [Abstract] [Full Text] [PDF]
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H. Barthel, S. Hesse, C. Dannenberg, A. Rossler, D. Schneider, W. H. Knapp, J. Dietrich, and J. Berrouschot Prospective Value of Perfusion and X-Ray Attenuation Imaging With Single-Photon Emission and Transmission Computed Tomography in Acute Cerebral Ischemia Stroke, July 1, 2001; 32(7): 1588 - 1597. [Abstract] [Full Text] [PDF]
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Recommendations for Clinical Trial Evaluation of Acute Stroke Therapies Stroke, July 1, 2001; 32(7): 1598 - 1606. [Abstract] [Full Text] [PDF]
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C. B. Grandin, T. P. Duprez, A. M. Smith, F. Mataigne, A. Peeters, C. Oppenheim, and G. Cosnard Usefulness of Magnetic Resonance-Derived Quantitative Measurements of Cerebral Blood Flow and Volume in Prediction of Infarct Growth in Hyperacute Stroke Stroke, May 1, 2001; 32(5): 1147 - 1153. [Abstract] [Full Text] [PDF]
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M. G. Lansberg, V. N. Thijs, M. W. O'Brien, J. O. Ali, A. J. de Crespigny, D. C. Tong, M. E. Moseley, and G. W. Albers Evolution of Apparent Diffusion Coefficient, Diffusion-weighted, and T2-weighted Signal Intensity of Acute Stroke AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 637 - 644. [Abstract] [Full Text]
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 D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Prediction of Hemorrhagic Transformation Following Acute Stroke: Role of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 587 - 593. [Abstract] [Full Text] [PDF]
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M. G. Lansberg, M. W. O'Brien, D. C. Tong, M. E. Moseley, and G. W. Albers Evolution of Cerebral Infarct Volume Assessed by Diffusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 613 - 617. [Abstract] [Full Text] [PDF]
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O. Wu, W. J. Koroshetz, L. Ostergaard, F. S. Buonanno, W. A. Copen, R. G. Gonzalez, G. Rordorf, B. R. Rosen, L. H. Schwamm, R. M. Weisskoff, et al. Predicting Tissue Outcome in Acute Human Cerebral Ischemia Using Combined Diffusion- and Perfusion-Weighted MR Imaging Stroke, April 1, 2001; 32(4): 933 - 942. [Abstract] [Full Text] [PDF]
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A.E. Hillis, P.B. Barker, N.J. Beauchamp, B.D. Winters, M. Mirski, and R.J. Wityk Restoring blood pressure reperfused Wernicke's area and improved language Neurology, March 13, 2001; 56(5): 670 - 672. [Abstract] [Full Text] [PDF]
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 A C Pereira, P J Martin, and E A Warburton Thrombolysis in acute ischaemic stroke Postgrad. Med. J., March 1, 2001; 77(905): 166 - 171. [Full Text]
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T. Neumann-Haefelin, M. Sitzer, R. du Mesnil de Rochemont, H. Lanfermann, Y. Samson, and C. Oppenheim Prediction of Malignant MCA Infarction With DWI: Pitfalls in Hyperacute Stroke Response Stroke, February 1, 2001; 32 (2): 580 - 583. [Full Text] [PDF]
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J. O. Karonen, Y. Liu, R. L. Vanninen, L. Østergaard, P. L. Kaarina Partanen, P. A. Vainio, E. J. Vanninen, J. Nuutinen, R. Roivainen, S. Soimakallio, et al. Combined Perfusion- and Diffusion-weighted MR Imaging in Acute Ischemic Stroke during the 1st Week: A Longitudinal Study Radiology, December 1, 2000; 217(3): 886 - 894. [Abstract] [Full Text]
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T. Back, J. G. Hirsch, K. Szabo, and A. Gass Failure to Demonstrate Peri-Infarct Depolarizations by Repetitive MR Diffusion Imaging in Acute Human Stroke Stroke, December 1, 2000; 31(12): 2901 - 2906. [Abstract] [Full Text] [PDF]
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 M. Fisher and W. Schaebitz An Overview of Acute Stroke Therapy: Past, Present, and Future Arch Intern Med, November 27, 2000; 160(21): 3196 - 3206. [Full Text] [PDF]
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J Federlein, T. Postert, S Meves, S Weber, H Przuntek, and T. Buttner Ultrasonic evaluation of pathological brain perfusion in acute stroke using second harmonic imaging J. Neurol. Neurosurg. Psychiatry, November 1, 2000; 69(5): 616 - 622. [Abstract] [Full Text] [PDF]
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P. W. Schaefer, P. E. Grant, and R. G. Gonzalez Diffusion-weighted MR Imaging of the Brain Radiology, November 1, 2000; 217(2): 331 - 345. [Abstract] [Full Text]
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V. N. Thijs, M. G. Lansberg, C. Beaulieu, M. P. Marks, M. E. Moseley, and G. W. Albers Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome? : A Multivariable Analysis Stroke, November 1, 2000; 31(11): 2597 - 2602. [Abstract] [Full Text] [PDF]
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S. L. Keir and J. M. Wardlaw Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke Stroke, November 1, 2000; 31(11): 2723 - 2731. [Abstract] [Full Text] [PDF]
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A. E. Hillis, P. B. Barker, N. J. Beauchamp, B. Gordon, and R. J. Wityk MR perfusion imaging reveals regions of hypoperfusion associated with aphasia and neglect Neurology, September 26, 2000; 55(6): 782 - 788. [Abstract] [Full Text] [PDF]
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D. G. Darby, M. W. Parsons, P. A. Barber, S. M. Davis, J.-K. Roh, and D.-W. Kang Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging Response Stroke, September 1, 2000; 31 (9): 2266 - 2278. [Full Text] [PDF]
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M. W. Parsons, T. Li, P. A. Barber, Q. Yang, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis Combined 1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome Neurology, August 22, 2000; 55(4): 498 - 506. [Abstract] [Full Text] [PDF]
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