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From the Departments of Radiology and Neurology (L.J.K.), University
Hospital Utrecht (Netherlands).
Background and
Purpose—Diffusion-weighted MRI (DWI) is highly sensitive in
detecting early cerebral ischemic changes in acute stroke
patients. In this study we compared the sensitivity of DWI with that of
conventional MRI techniques. Furthermore, we investigated the
prognostic value of the volume of ischemic lesions on DWI scans
and of the apparent diffusion coefficient (ADC).
Methods—We performed DWI, fluid-attenuated inversion recovery,
spin-echo T2-weighted MRI, and spin-echo proton density–weighted MRI
in 42 patients with acute stroke and 15 control subjects. The volume of
ischemic lesions was measured on early (<60 hours after onset)
and follow-up MRI scans. Clinical outcome was measured 4 months after
onset of symptoms with the National Institutes of Health Stroke Scale,
the Barthel Index, and the Rankin Scale.
Results—With DWI, 98% of the ischemic lesions were
detected, and with fluid-attenuated inversion recovery, 91% were
detected, whereas with early T2-weighted or proton density–weighted
scans, only 71% (P=0.002,
Conclusions—DWI is a better imaging method than conventional MRI
in detecting early ischemic lesions in stroke patients. Lesion
size as measured on DWI scans and, to a lesser extent, ADC values are
potential parameters for predicting clinical outcome in
acute stroke patients.
© 1998 American Heart Association, Inc.
Original Contributions
Diffusion-Weighted Magnetic Resonance Imaging in Acute Stroke
2) and 80%
(P=0.02, 2) of lesions, respectively,
were found. Lesion volume on early DWI scans correlated significantly
with clinical outcome ratings (P<0.01). In patients
with a first-ever stroke, a lesion volume of 
22 mL on DWI predicted
good outcome with a 75% sensitivity and a 100% specificity. The mean
ADC of ischemic lesions was 29% lower than the ADC of
normal-appearing parts of the brain (P<0.001). The ADC
ratio correlated significantly with clinical outcome
(P<0.05).
Key Words: cerebral infarction • magnetic resonance imaging • stroke assessment • stroke, acute
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