From the Departments of Neurology (V.N., K.M.A.W., S.R.L., L.D'O.,
M.D.B.) and Diagnostic Radiology (J.P.W., S.P., D.H., D.P., K.R., H.S.-Z.),
Nuclear Magnetic Resonance and Stroke Research Centers, Henry Ford Health
Sciences Center, Detroit Campus of Case Western Reserve University, Detroit,
Mich; and Department of Electrical and Computer Engineering, University of
Tehran, Tehran, Iran (H.S.-Z.).
Correspondence to Dr K.M.A Welch, NMR Research Center, Department of Neurology (K-11), Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202-2689. E-mail cwmru{at}neuro.hfh.edu
Background and Purpose—Using
newly developed computerized image analysis, we studied the
heterogeneity of apparent diffusion coefficient of
water (ADCw) values in human ischemic stroke within
10 hours of onset.
Methods—Echo-planar trace diffusion-weighted images from 9
patients with focal cortical ischemic stroke were obtained
within 10 hours of symptom onset. An Iterative Self-Organizing Data
Analysis (ISODATA) clustering algorithm was implemented to
segment different tissue types with a series of DW images.
ADCw maps were calculated from 4 DW images on a
pixel-by-pixel basis. The segmented zones within the lesion were
characterized as low, pseudonormal, or high, expressed as a ratio of
the mean±SD of ADCw of contralateral noninvolved
tissue.
Results—The average ADCw in the ischemic
stroke region within 10 hours of onset was significantly depressed
compared with homologous contralateral tissue (626.6±76.8 versus
842.9±60.4x10-6 mm2/s;
P<0.0001). Nevertheless, ISODATA segmentation yielded
multiple zones within the stroke region that were characterized as low,
pseudonormal, and high. The mean proportion of low:pseudonormal:high
was 72%:20%:8%.
Conclusions—Despite low average ADCw,
computer-assisted segmentation of DW MRI detected
heterogeneous zones within ischemic lesions
corresponding to low, pseudonormal, and high ADCw not
visible to the human eye. This supports acute elevation of
ADCw in human ischemic stroke and, accordingly,
different temporal rates of tissue evolution toward infarction.
© 1998 American Heart Association, Inc.
Original Contributions
Time Course of ADCw Changes in Ischemic Stroke: Beyond the Human Eye!
Key Words: cerebral ischemia, focal • magnetic resonance imaging • signal processing, computer assisted • stroke, acute
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