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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 62, Number 4, February 24, 2004 Data supplement Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Engelter, S. T. Articles by Lyrer, P. A. Search for Related Content PubMed PubMed Citation Articles by Engelter, S. T. Articles by Lyrer, P. A. Related Collections MRI DWI All Cerebrovascular disease/Stroke Infarction

The clinical significance of diffusion-weighted MR imaging in infratentorial strokes

From the Neurological Clinic and Stroke Unit (Drs. Engelter, Steck, and Lyrer) and Department of Radiology (Drs. Wetzel, Radue, and Rausch), University Hospital Basel, Switzerland.

Address correspondence and reprint requests to Dr. S.T. Engelter, Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: sengelter{at}uhbs.ch

Objective: To study the association between diffusion-weighted imaging (DWI) characteristics and stroke etiology, stroke severity, and functional outcome in patients with infratentorial strokes.

Methods: The authors prospectively studied 22 consecutive patients with acute infratentorial strokes. They used a blinded comparison of DWI features (number, distribution, and volume of lesions) with clinical characteristics, namely, stroke etiology (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), severity (NIH Stroke Scale [NIHSS]), length of stay (LOS), and functional 3-month outcome using modified Rankin Scale, Barthel Index, and a dichotomized outcome status (living at home vs institutionalization or death).

Results: Acute infratentorial DWI lesions were detected in 95% (21/22) of the patients. The number (p = 0.01) and the distribution (p < 0.001) of DWI lesions were correlated with stroke etiology. Patients with cardioembolic strokes (n = 5) had more DWI lesions (8.0 ± 6.0) than those with other stroke etiologies (n = 17; 1.3 ± 0.9; p < 0.001). Their lesion distribution differed from that of patients with noncardioembolic strokes (p < 0.001). Clinically silent, acute DWI lesions in the anterior circulation in addition to their infratentorial lesions were visualized in 3 of 5 patients with cardioembolic stroke and in none of 17 patients without sources of cardioembolism (p < 0.001). Pure infratentorial lesions were present in 15 of 17 patients with noncardioembolic strokes and in none of 5 cardioembolic stroke patients (p < 0.001). DWI lesion volume was not correlated with NIHSS score, LOS, outcome scores, or outcome status.

Conclusion: In infratentorial strokes, multiple DWI lesions and a distribution of subsidiary, clinically silent DWI lesions in the anterior circulation suggest a cardioembolic stroke etiology. However, DWI lesion volume did not correlate with the NIHSS score and was no predictor of outcome.

Received January 22, 2003. Accepted in final form October 28, 2003.

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