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NEUROLOGY 1998;51:418-426
© 1998 American Academy of Neurology

Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI

P. A. Barber, FRACP, D. G. Darby, PhD, FRACP, P. M. Desmond, MSc, FRACR, Q. Yang, PhD, R. P. Gerraty, MD, FRACP, D. Jolley, MSc, G. A. Donnan, MD, FRACP, B. M. Tress, MD, FRACR and S. M. Davis, MD, FRACP

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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StrokeHome page
J. F. Arenillas, A. Rovira, C. A. Molina, E. Grive, J. Montaner, J. Alvarez-Sabin, and K.-O. Lovblad
Prediction of Early Neurological Deterioration Using Diffusion- and Perfusion-Weighted Imaging in Hyperacute Middle Cerebral Artery Ischemic Stroke * Editorial Comment
Stroke, September 1, 2002; 33(9): 2197 - 2205.
[Abstract] [Full Text] [PDF]


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StrokeHome page
J.B. Fiebach, P.D. Schellinger, O. Jansen, M. Meyer, P. Wilde, J. Bender, P. Schramm, E. Juttler, J. Oehler, M. Hartmann, et al.
CT and Diffusion-Weighted MR Imaging in Randomized Order: Diffusion-Weighted Imaging Results in Higher Accuracy and Lower Interrater Variability in the Diagnosis of Hyperacute Ischemic Stroke
Stroke, September 1, 2002; 33(9): 2206 - 2210.
[Abstract] [Full Text] [PDF]


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StrokeHome page
R. P. Gerraty, M. W. Parsons, P. A. Barber, D. G. Darby, P. M. Desmond, B. M. Tress, and S. M. Davis
Examining the Lacunar Hypothesis With Diffusion and Perfusion Magnetic Resonance Imaging
Stroke, August 1, 2002; 33(8): 2019 - 2024.
[Abstract] [Full Text] [PDF]


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StrokeHome page
M. Wintermark, M. Reichhart, O. Cuisenaire, P. Maeder, J.-P. Thiran, P. Schnyder, J. Bogousslavsky, and R. Meuli
Comparison of Admission Perfusion Computed Tomography and Qualitative Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging in Acute Stroke Patients
Stroke, August 1, 2002; 33(8): 2025 - 2031.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
M. W. Parsons, P. A. Barber, S. M. Davis, V. Thijs, and G. W. Albers
Relationship between severity of MR perfusion deficit and DWI lesion evolution
Neurology, June 11, 2002; 58(11): 1707 - 1707.
[Full Text] [PDF]


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StrokeHome page
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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BrainHome page
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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StrokeHome page
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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NeurologyHome page
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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StrokeHome page
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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NeurologyHome page
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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RadiologyHome page
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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NeurologyHome page
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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NeurologyHome page
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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Am. J. Neuroradiol.Home page
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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StrokeHome page
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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StrokeHome page
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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StrokeHome page
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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StrokeHome page
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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StrokeHome page
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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Am. J. Neuroradiol.Home page
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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Arch NeurolHome page
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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Arch NeurolHome page
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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StrokeHome page
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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NeurologyHome page
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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Postgrad. Med. J.Home page
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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StrokeHome page
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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RadiologyHome page
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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StrokeHome page
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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Arch Intern MedHome page
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. Neurol. Neurosurg. PsychiatryHome page
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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RadiologyHome page
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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StrokeHome page
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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StrokeHome page
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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NeurologyHome page
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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StrokeHome page
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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NeurologyHome page
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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