From the Department of Neurology (G.R., W.J.K., S.C.C., L.H.S., F.B.,
A.G.S., G.G.) and Division of Neuroradiology (W.A.C., P.W.S., R.F.B.),
Massachusetts General Hospital, Boston.
Correspondence to Guy Rordorf, MD, Department of Neurology, Massachusetts General Hospital, BLK 1291, Fruit St, Boston, MA 02114. E-mail rordorf{at}helix.mgh.harvard.edu
Background and Purpose—We sought to
map early regional ischemia and infarction in patients with
middle cerebral artery (MCA) stroke and compare them with final infarct
size using advanced MRI techniques. MRI can now delineate very early
infarction by diffusion-weighted imaging (DWI) and abnormal tissue
perfusion by perfusion-weighted imaging (PWI).
Methods—Seventeen patients seen within 12 hours of onset of MCA
stroke had MR angiography, standard MRI, and PWI and DWI MRI. PWI maps
were generated by analysis of the passage of
intravenous contrast bolus through the brain. Cerebral
blood volume (CBV) was determined after quantitative analysis
of PWI data. Volumes of the initial DWI and PWI lesion were calculated
and compared with a final infarct volume from a follow-up imaging study
(CT scan or MRI).
Results—Group 1 (10 patients) had MCA stem (M1) occlusion by MR
angiography. DWI lesion volumes were smaller than the volumes of CBV
abnormality. In 7 patients the final stroke volume was larger or the
same, and in 3 it was smaller than the initial CBV lesion. Group 2 (7
patients) had an open M1 on MR angiography with distal MCA stroke. In 6
group 2 patients, the initial DWI lesion matched the initial CBV
abnormality and the final infarct.
Conclusions—Most patients with M1 occlusion showed progression of
infarction into the region of abnormal perfusion. In contrast, patients
with open M1 had strokes consistent with distal branch
occlusion and had maximal extent of injury on DWI at initial
presentation. Application of these MRI techniques should
improve definition of different acute stroke syndromes and facilitate
clinical decision making.
© 1998 American Heart Association, Inc.
Original Contributions
Regional Ischemia and Ischemic Injury in Patients With Acute Middle Cerebral Artery Stroke as Defined by Early Diffusion-Weighted and Perfusion-Weighted MRI
Key Words: middle cerebral artery • stroke • magnetic resonance imaging • diffusion-weighted imaging • perfusion-weighted imaging
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