(Stroke. 1999;30:2382-2390.)
© 1999 American Heart Association, Inc.
Original Contributions |
Serial Study of Apparent Diffusion Coefficient and Anisotropy in Patients With Acute Stroke
Presented in part at the Annual Meeting of the American Society of Neuroradiology, San Diego, Calif, May 23–28, 1999.
From the Departments of Radiology (Q.Y., B.M.T., P.M.D, T.L.) and Neurology (P.A.B., D.G.D., R.P.G., S.M.D), Royal Melbourne Hospital and University of Melbourne, Victoria, Australia.
Correspondence to Dr Qing Yang, Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. E-mail QY{at}radior.medrmh.unimelb.edu.au
Background and Purpose—We sought to characterize the evolution of apparent diffusion coefficient (ADC) and apparent diffusion anisotropy (ADA) in acute stroke and to evaluate their roles in predicting stroke evolution and outcome.
Methods—We studied 26 stroke patients acutely (<24 hours), subacutely (3 to 5 days), and at outcome (3 months). Ratios of the ADC and ADA within a region of infarction and the normal contralateral region were evaluated and compared with the Canadian Neurological Scale, Barthel Index, and Rankin Scale.
Results—Heterogeneity in ADC and ADA evolution was observed not only between patients but also within individual lesions. Three patterns of ADA evolution were observed: (1) elevated ADA acutely and subacutely; (2) elevated ADA acutely and reduced ADA subacutely; and (3) reduced ADA acutely and subacutely. At outcome, reduced ADA with elevated ADC was observed generally. We identified 3 phases of diffusion abnormalities: (1) reduced ADC and elevated ADA; (2) reduced ADC and reduced ADA; and (3) elevated ADC and reduced ADA. The ADA ratios within 12 hours correlated with the acute Canadian Neurological Scale (r=0.46, P=0.06), subacute Canadian Neurological Scale (r=0.55, P=0.02), outcome Barthel Index (r=0.62, P=0.01), and Rankin Scale (r=-0.77, P<0.0005) scores.
Conclusions—Combined ADC and ADA provide differential patterns of stroke evolution. Early ADA changes reflect cellular alterations in acute ischemia and may provide a potential marker to predict stroke outcome.
Key Words: cerebral edema • cerebral infarction • magnetic resonance imaging, diffusion-weighted • stroke, ischemic • stroke outcome
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