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(Stroke. 2009;40:1692.)
© 2009 American Heart Association, Inc.

Original Contributions

Relationships Between Cerebral Perfusion and Reversibility of Acute Diffusion Lesions in DEFUSE

Insights from RADAR

Jean-Marc Olivot, MD, PhD; Michael Mlynash, MD, MS; Vincent N. Thijs, MD, PhD; Archana Purushotham, MBBS, PhD; Stephanie Kemp, BS; Maarten G. Lansberg, MD, PhD; Lawrence Wechsler, MD; Roland Bammer, PhD; Michael P. Marks, MD Gregory W. Albers, MD

From the Department of Neurology and Neurological Sciences and the Stanford Stroke Center (J.-M.O., M.M., S.K., M.G.L., G.W.A.), Stanford University Medical Center, Stanford Calif; the Department of Neurology (V.N.T.), University Hospitals Leuven, and the Belgium & Vesalius Research Center (V.N.T.), VIB, Leuven, Belgium; UMPC Stroke Institute and Department of Neurology (L.W.), University of Pittsburgh, Pa; and the Department of Radiology and the Stanford Stroke Center (R.B., M.P.M.), Stanford University Medical Center, Stanford, Calif.

Correspondence to Dr J.M. Olivot, Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical center, 701 Welch Road, Suite 325, Palo Alto, CA 94304. E-mail jmolivot{at}stanford.edu

Background and Purpose— Acute ischemic lesions with restricted diffusion can resolve after early recanalization. The impact of superimposed perfusion abnormalities on the fate of acute diffusion lesions is unclear.

Methods— Data were obtained from DEFUSE, a prospective multicenter study of patients treated with IV tPA 3 to 6 hours after stroke onset. Thirty-two patients with baseline diffusion and perfusion lesions and 30 day FLAIR scans were coregistered. The acute diffusion lesion was divided into 3 regions according to the Tmax delay of the superimposed perfusion lesion: normal baseline perfusion; mild-moderately hypoperfused (2 s<Tmax8 s) and severely hypoperfused (Tmax >8 s). The reversal rate was calculated as the percentage of the acute diffusion lesion that did not overlap with the final infarct on 30-day FLAIR. Diffusion reversal rates were compared based on whether a favorable clinical response occurred and whether early recanalization was achieved.

Results— On average, 54% of the acute diffusion lesion volume had normal perfusion. Diffusion reversal rates were significantly increased among cases with favorable clinical response and in patients with early recanalization, especially in regions with normal baseline perfusion. The portion of the diffusion lesion with normal perfusion had significantly higher mean apparent diffusion coefficient values and reversal rates.

Conclusion— Acute ischemic lesions with restricted diffusion are most likely to recover if reperfusion occurs within 6 hours of symptom onset, and reversibility is associated with early recanalization and favorable clinical outcome. We propose the term RADAR (Reversible Acute Diffusion lesion Already Reperfused) to describe regions of acute restricted diffusion with normal perfusion.

Key Words: brain infarction • cerebral infarct • magnetic resonance • thrombolysis

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				J.-M. Olivot, M. Mlynash, V. N. Thijs, A. Purushotham, S. Kemp, M. G. Lansberg, L. Wechsler, G. E. Gold, R. Bammer, M. P. Marks, et al. Geography, Structure, and Evolution of Diffusion and Perfusion Lesions in Diffusion and Perfusion Imaging Evaluation For Understanding Stroke Evolution (DEFUSE) Stroke, October 1, 2009; 40(10): 3245 - 3251. [Abstract] [Full Text] [PDF]