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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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