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From the Calgary Stroke Program (P.N.S., S.B.C., S.S., M.D.H., A.M.D.), Department of Clinical Neurosciences, and Department of Community Health Sciences (M.E.), University of Calgary, Calgary, Alberta, Canada.
Address correspondence and reprint requests to Dr Demchuk, Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Rm. 1162, University of Calgary, Calgary, Alberta, Canada T2N 2T9; e-mail: ademchuk{at}ucalgary.ca
Background: Multiple ischemic lesions identified by diffusion-weighted imaging (DWI) have been shown to predict high risk of future ischemic events. However, the importance of lesion age has not been factored into this risk. Our goal was to evaluate whether the presence of ischemic lesions of varying ages identified by DWI and apparent diffusion coefficient (ADC) suggests a higher risk of future ischemic events.
Methods: Patients with acute stroke and TIA presenting within 12 hours of symptom onset who had a baseline and 1-month follow-up MRI were enrolled in the study. Acute ischemic lesions were divided into DWI positive with ADC low lesions and DWI positive with ADC normalized lesions. The baseline MRI and the presence of new lesions on the follow-up MRI were analyzed.
Results: A total of 360 patients were prospectively enrolled, and all had appropriate imaging. Two hundred twenty-three were excluded as there were no DWI lesions, they received recombinant tissue plasminogen activator, or they did not have the 30-day follow-up MRI. One hundred seventeen patients had DWI lesions of one age (DWI positive with either ADC low lesions or ADC normalized lesions alone) and 20 had lesions of varying ages (DWI positive lesions with reduced and normalized ADC) on the baseline MRI. Patients with multiple DWI lesions of varying ages were at more risk of having new lesions on the 30-day MRI compared with those having lesions of the same age (relative risk = 3.6; 95% CI 1.9 to 6.8). Multiple DWI lesions of varying ages (odds ratio [OR] 6.6; 95% CI 2.3 to 19.1) and cardioembolic stroke subtype (OR 3.2; 95% CI 1.1 to 8.7) were independently associated with new lesion recurrence by multiple logistic regression analysis.
Conclusion: The presence of multiple diffusion-weighted imaging lesions of varying ages suggests very active early recurrence over time and portends a higher early risk of future ischemic events.
Editorial, see page 398
Supported by grant funding from the Canadian Institutes for Health Research (MOP-118096) and Heart and Stroke Foundation of Alberta, NWT, and Nunavut. The 3.0 T MR Scanner in the Seaman Family MR Research Centre used in this study was partially funded by Canada Foundation for Innovation. Acute stroke imaging was also supported by the Alberta Foundation for Health Research.
Disclosure: Drs. Demchuk, Eliasziw, and Coutts received salary support from the Alberta Heritage Foundation for Medical Research. Drs. Demchuk and Hill received salary support from the Canadian Institutes of Health Research. Drs. Hill and Coutts received salary support from the Heart and Stroke Foundation of Canada. Dr. Eliasziw received salary support from the Natural Sciences and Engineering Research Council of Canada.
Received June 5, 2006. Accepted in final form October 13, 2006.
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Neurology 2007 68: 397.
Neurology 2007 68: 398-399.
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