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(Stroke. 2006;37:98.)
© 2006 American Heart Association, Inc.

Original Contributions

Do Acute Diffusion- and Perfusion-Weighted MRI Lesions Identify Final Infarct Volume in Ischemic Stroke?

C.S. Rivers, MSc; J.M. Wardlaw, MBChB, MD, FRCR, FRCP, FmedSci; P.A. Armitage, PhD; M.E. Bastin, Dphil; T.K. Carpenter, PhD; V. Cvoro, MBChB, MD, MRCP; P.J. Hand, MBChB, MD, MRCP M.S. Dennis, MD, FRCP

From the Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.

Correspondence to Professor J.M. Wardlaw, Division of Clinical Neurosciences, Bramwell-Dott Building, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, UK. E-mail jmw{at}skull.dcn.ed.ac.uk

Background and Purpose— An acute mismatch on diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) may represent the "tissue-at-risk." It is unclear which "semiquantitative" perfusion parameter most closely identifies final infarct volume.

Methods— Acute stroke patients underwent DWI and PWI (dynamic-susceptibility contrast imaging) on admission (baseline), and T₂-weighted imaging (T₂WI) at 1 or 3 months after stroke. "Semiquantitative" mean transit time (MTT_sq=first moment of concentration/time curve), cerebral blood volume (CBV_sq=area under concentration/time curve), and cerebral blood flow (CBF_sq=CBV_sq/MTT_sq) were calculated. DWI and PWI lesions were measured at baseline and final infarct volume on T₂WI acquired 1 month after stroke. Baseline DWI, CBF_sq, and MTT_sq lesion volumes were compared with final T₂WI lesion volume.

Results— Among 46 patients, baseline DWI and CBF_sq lesions were not significantly different from final T₂WI lesion volume, but baseline MTT_sq lesions were significantly larger. The correlation with final T₂WI lesion volume was strongest for DWI (Spearman rank correlation coefficient =0.68), intermediate for CBF_sq (=0.55), and weakest for MTT_sq (=0.49) baseline lesion volumes. Neither DWI/CBF_sq nor DWI/MTT_sq mismatch predicted lesion growth; lesion growth was equally common in those with and without mismatch.

Conclusions— Of the 2 PWI parameters, CBF_sq lesions most closely identifies, and MTT_sq overestimates, final T₂WI lesion volume. "DWI/PWI mismatch" does not identify lesion growth. Patients without "DWI/PWI mismatch" are equally likely to have lesion growth as those with mismatch and should not be excluded from acute stroke treatment.

Key Words: cerebrovascular disorders • imaging, diffusion-weighted • imaging, perfusion-weighted • magnetic resonance imaging • stroke

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