(Stroke. 1998;29:2268-2276.)
© 1998 American Heart Association, Inc.
Original Contributions |
Time Course of Lesion Development in Patients With Acute Stroke
Serial Diffusion- and Hemodynamic-Weighted Magnetic Resonance Imaging
From the Departments of Neurology (L.H.S., W.J.K., G.R., F.S.B.) and Neuroradiology (A.G.S., B.W., W.A.C., R.B., P.W.S., G.G.), Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
Correspondence to Walter J. Koroshetz, MD, Department of Neurology VBK 915, Massachusetts General Hospital, 32 Fruit St, Boston, MA 02114. E-mail Koroshetz{at}helix.mgh.harvard.edu
Background and Purpose—We sought to characterize the evolution of acute ischemic stroke by MRI and its relationship to patients' neurological outcome.
Methods—Fourteen patients with acute ischemic stroke underwent MRI within 13 hours of symptom onset (mean, 7.4±3 hours) and underwent repeated imaging and concurrent neurological examination at 8, 24, 36, and 48 hours and 7 days and >42 days after first imaging.
Results—Diffusion-weighted imaging (DWI) lesion volumes increased between the first and second scans in 10 of 14 patients; scans with maximum DWI lesion volume occurred at a mean of 70.4 hours. Initial DWI lesion volume correlated with the largest T2 lesion volume (r=0.97; P<0.001). Final lesion volume was smaller than maximum lesion volume in 12 of 14 patients. There was positive correlation between the follow-up National Institutes of Health Stroke Scale score and the initial DWI lesion volume (r=0.67; P=0.01) and maximum T2 lesion volume (r=0.77; P<0.01) and negative correlation with initial mean apparent diffusion coefficient ratio (ADCr) (r=-0.64; P<0.05). The ADCr was 0.73 at initial imaging and fell between the initial and second scans in 10 of 14 patients. Mean ADCr did not rise above normal until 42 days after stroke onset (P<0.001).
Conclusions—Serial MRI demonstrates the dynamic nature of progressive ischemic injury in acute stroke patients developing over hours to days, and it suggests that both primary and secondary pathophysiological processes can be valuable targets for neuroprotective interventions.
Key Words: diffusion • magnetic resonance imaging • perfusion • stroke, acute
This article has been cited by other articles:
 |
|
 |
|
  J. Whitehead, K. Bolland, E. Valdes-Marquez, A. Lihic, M. Ali, K. Lees, and for the VISTA Collaborators Using Historical Lesion Volume Data in the Design of a New Phase II Clinical Trial in Acute Stroke Stroke, April 1, 2009; 40(4): 1347 - 1352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ebinger, S. Christensen, D. A. De Silva, M. W. Parsons, C. R. Levi, K. S. Butcher, C. F. Bladin, P. A. Barber, G. A. Donnan, S. M. Davis, et al. Expediting MRI-Based Proof-of-Concept Stroke Trials Using an Earlier Imaging End Point Stroke, April 1, 2009; 40(4): 1353 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Gaudinski, E. C. Henning, A. Miracle, M. Luby, S. Warach, and L. L. Latour Establishing Final Infarct Volume: Stroke Lesion Evolution Past 30 Days Is Insignificant Stroke, October 1, 2008; 39(10): 2765 - 2768. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Fogal, J. Li, D. Lobner, L. D. McCullough, and S. J. Hewett System xc Activity and Astrocytes Are Necessary for Interleukin-1{beta}-Mediated Hypoxic Neuronal Injury J. Neurosci., September 19, 2007; 27(38): 10094 - 10105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. N. Sylaja, S. B. Coutts, S. Subramaniam, M. D. Hill, M. Eliasziw, A. M. Demchuk, and for the VISION Study Group Acute ischemic lesions of varying ages predict risk of ischemic events in stroke/TIA patients Neurology, February 6, 2007; 68(6): 415 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Srinivasan, M. Goyal, F. A. Azri, and C. Lum State-of-the-Art Imaging of Acute Stroke RadioGraphics, October 1, 2006; 26(suppl_1): S75 - S95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Seitz, S. Meisel, P. Weller, U. Junghans, H.-J. Wittsack, and M. Siebler Initial Ischemic Event: Perfusion-weighted MR Imaging and Apparent Diffusion Coefficient for Stroke Evolution Radiology, December 1, 2005; 237(3): 1020 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, W. J. Koroshetz, M. Vangel, T. Benner, C. Melinosky, M. Zhu, N. Menezes, C. J. Lopez, and A. G. Sorensen Conversion of Ischemic Brain Tissue Into Infarction Increases With Age Stroke, December 1, 2005; 36(12): 2632 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S M. Maniega, M E Bastin, P A Armitage, A J Farrall, T K Carpenter, P J Hand, V Cvoro, C S Rivers, and J M Wardlaw Temporal evolution of water diffusion parameters is different in grey and white matter in human ischaemic stroke J. Neurol. Neurosurg. Psychiatry, December 1, 2004; 75(12): 1714 - 1718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. G. Schulz, D. Briley, T. Meagher, A. Molyneux, and P. M. Rothwell Diffusion-Weighted MRI in 300 Patients Presenting Late With Subacute Transient Ischemic Attack or Minor Stroke Stroke, November 1, 2004; 35(11): 2459 - 2465. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. White, Y. Zhang, and W. R. K. Smoker Evolution of Lesions in Susac Syndrome at Serial MR Imaging with Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Values AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 706 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Bykowski, L. L. Latour, and S. Warach More Accurate Identification of Reversible Ischemic Injury in Human Stroke by Cerebrospinal Fluid Suppressed Diffusion-Weighted Imaging Stroke, May 1, 2004; 35(5): 1100 - 1106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Winbeck, K. Bruckmaier, T. Etgen, H. G. von Einsiedel, M. Rottinger, and D. Sander Transient Ischemic Attack and Stroke Can Be Differentiated by Analyzing Early Diffusion-Weighted Imaging Signal Intensity Changes Stroke, May 1, 2004; 35(5): 1095 - 1099. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Finnigan, S. E. Rose, M. Walsh, M. Griffin, A. L. Janke, K. L. McMahon, R. Gillies, M. W. Strudwick, C. M. Pettigrew, J. Semple, et al. Correlation of Quantitative EEG in Acute Ischemic Stroke With 30-Day NIHSS Score: Comparison With Diffusion and Perfusion MRI Stroke, April 1, 2004; 35(4): 899 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U G R Schulz, D Briley, T Meagher, A Molyneux, and P M Rothwell Abnormalities on diffusion weighted magnetic resonance imaging performed several weeks after a minor stroke or transient ischaemic attack J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 734 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Eastwood, S. T. Engelter, J. F. MacFall, D. M. Delong, and J. M. Provenzale Quantitative Assessment of the Time Course of Infarct Signal Intensity on Diffusion-Weighted Images AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 680 - 687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Latchaw, H. Yonas, G. J. Hunter, W. T.C. Yuh, T. Ueda, A. G. Sorensen, J. L. Sunshine, J. Biller, L. Wechsler, R. Higashida, et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association Stroke, April 1, 2003; 34(4): 1084 - 1104. [Full Text] [PDF]
|
|
|
|
|
|
P. W. Schaefer, G. J. Hunter, J. He, L. M. Hamberg, A. G. Sorensen, L. H. Schwamm, W. J. Koroshetz, and R. G. Gonzalez Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging AJNR Am. J. Neuroradiol., November 1, 2002; 23(10): 1785 - 1794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. S. Caviness, N. Makris, E. Montinaro, N. T. Sahin, J. F. Bates, L. Schwamm, D. Caplan, and D. N. Kennedy Anatomy of Stroke, Part I: An MRI-Based Topographic and Volumetric System of Analysis Stroke, November 1, 2002; 33(11): 2549 - 2556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Mullins, P. W. Schaefer, A. G. Sorensen, E. F. Halpern, H. Ay, J. He, W. J. Koroshetz, and R. G. Gonzalez CT and Conventional and Diffusion-weighted MR Imaging in Acute Stroke: Study in 691 Patients at Presentation to the Emergency Department Radiology, August 1, 2002; 224(2): 353 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B. Singhal, M. A. Topcuoglu, and F. S. Buonanno Acute Ischemic Stroke Patterns in Infective and Nonbacterial Thrombotic Endocarditis: A Diffusion-Weighted Magnetic Resonance Imaging Study Stroke, May 1, 2002; 33(5): 1267 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Mader, M. Schoning, U. Klose, and W. Kuker Neonatal Cerebral Infarction Diagnosed by Diffusion-Weighted MRI: Pseudonormalization Occurs Early Stroke, April 1, 2002; 33(4): 1142 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, M. Foth, T. Kucinski, R. Knab, M. von Bezold, C. Weiller, H. Zeumer, and J. Rother Severe ADC Decreases Do Not Predict Irreversible Tissue Damage In Humans Stroke, January 1, 2002; 33(1): 79 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Perkins, E. Kahya, C. T. Roque, P. E. Roche, G. C. Newman, and S. Warach Fluid-Attenuated Inversion Recovery and Diffusion- and Perfusion-Weighted MRI Abnormalities in 117 Consecutive Patients With Stroke Symptoms Editorial Comment Stroke, December 1, 2001; 32(12): 2774 - 2781. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Oppenheim, C. Grandin, Y. Samson, A. Smith, T. Duprez, C. Marsault, and G. Cosnard Is There an Apparent Diffusion Coefficient Threshold in Predicting Tissue Viability in Hyperacute Stroke? Stroke, November 1, 2001; 32(11): 2486 - 2491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. N. Thijs, A. Adami, T. Neumann-Haefelin, M. E. Moseley, M. P. Marks, and G. W. Albers Relationship between severity of MR perfusion deficit and DWI lesion evolution Neurology, October 9, 2001; 57(7): 1205 - 1211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Copen, L. H. Schwamm, R. G. Gonzalez, O. Wu, C. B. Harmath, P. W. Schaefer, W. J. Koroshetz, and A. G. Sorensen Ischemic Stroke: Effects of Etiology and Patient Age on the Time Course of the Core Apparent Diffusion Coefficient Radiology, October 1, 2001; 221(1): 27 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I.-J. Huang, C.-Y. Chen, H.-W. Chung, D.-C. Chang, C.-C. Lee, S.-C. Chin, and M. Liou Time Course of Cerebral Infarction in the Middle Cerebral Arterial Territory: Deep Watershed versus Territorial Subtypes on Diffusion-weighted MR Images Radiology, October 1, 2001; 221(1): 35 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Grant, J. He, E. F. Halpern, O. Wu, P. W. Schaefer, L. H. Schwamm, R. F. Budzik, A. G. Sorensen, W. J. Koroshetz, and R. G. Gonzalez Frequency and Clinical Context of Decreased Apparent Diffusion Coefficient Reversal in the Human Brain Radiology, October 1, 2001; 221(1): 43 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Staroselskaya, C. Chaves, B. Silver, I. Linfante, R. R. Edelman, L. Caplan, S. Warach, and A. E. Baird Relationship Between Magnetic Resonance Arterial Patency and Perfusion-Diffusion Mismatch in Acute Ischemic Stroke and Its Potential Clinical Use Arch Neurol, July 1, 2001; 58(7): 1069 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.J. Kelly, E.T. Hedley-Whyte, J. Primavera, J. He, and R.G. Gonzalez Diffusion MRI in ischemic stroke compared to pathologically verified infarction Neurology, April 10, 2001; 56(7): 914 - 920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Lansberg, V. N. Thijs, M. W. O'Brien, J. O. Ali, A. J. de Crespigny, D. C. Tong, M. E. Moseley, and G. W. Albers Evolution of Apparent Diffusion Coefficient, Diffusion-weighted, and T2-weighted Signal Intensity of Acute Stroke AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 637 - 644. [Abstract] [Full Text]
|
|
|
|
|
|
R. L. Levine One-Stop Shopping: Stroke Questions Further Answered With Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 555 - 556. [Full Text] [PDF]
|
|
|
|
|
|
M. G. Lansberg, M. W. O'Brien, D. C. Tong, M. E. Moseley, and G. W. Albers Evolution of Cerebral Infarct Volume Assessed by Diffusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 613 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Wu, W. J. Koroshetz, L. Ostergaard, F. S. Buonanno, W. A. Copen, R. G. Gonzalez, G. Rordorf, B. R. Rosen, L. H. Schwamm, R. M. Weisskoff, et al. Predicting Tissue Outcome in Acute Human Cerebral Ischemia Using Combined Diffusion- and Perfusion-Weighted MR Imaging Stroke, April 1, 2001; 32(4): 933 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, M. Sitzer, R. du Mesnil de Rochemont, H. Lanfermann, Y. Samson, and C. Oppenheim Prediction of Malignant MCA Infarction With DWI: Pitfalls in Hyperacute Stroke Response Stroke, February 1, 2001; 32 (2): 580 - 583. [Full Text] [PDF]
|
|
|
|
|
|
T. Back, J. G. Hirsch, K. Szabo, and A. Gass Failure to Demonstrate Peri-Infarct Depolarizations by Repetitive MR Diffusion Imaging in Acute Human Stroke Stroke, December 1, 2000; 31(12): 2901 - 2906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Schaefer, P. E. Grant, and R. G. Gonzalez Diffusion-weighted MR Imaging of the Brain Radiology, November 1, 2000; 217(2): 331 - 345. [Abstract] [Full Text]
|
|
|
|
|
|
V. N. Thijs, M. G. Lansberg, C. Beaulieu, M. P. Marks, M. E. Moseley, and G. W. Albers Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome? : A Multivariable Analysis Stroke, November 1, 2000; 31(11): 2597 - 2602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Krueger, H. Kugel, M. Grond, A. Thiel, D. Maintz, and K. Lackner Late Resolution of Diffusion-Weighted MRI Changes in a Patient With Prolonged Reversible Ischemic Neurological Deficit After Thrombolytic Therapy Stroke, November 1, 2000; 31(11): 2715 - 2718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Keir and J. M. Wardlaw Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke Stroke, November 1, 2000; 31(11): 2723 - 2731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Lansberg, A. M. Norbash, M. P. Marks, D. C. Tong, M. E. Moseley, and G. W. Albers Advantages of Adding Diffusion-Weighted Magnetic Resonance Imaging to Conventional Magnetic Resonance Imaging for Evaluating Acute Stroke Arch Neurol, September 1, 2000; 57(9): 1311 - 1316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Oppenheim, D Galanaud, Y Samson, M Sahel, D Dormont, B Wechsler, and C Marsault Can diffusion weighted magnetic resonance imaging help differentiate stroke from stroke-like events in MELAS? J. Neurol. Neurosurg. Psychiatry, August 1, 2000; 69(2): 248 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Williams, J. R. Dave, J. B. Phillips, Y. Lin, R. T. McCabe, and F. C. Tortella Neuroprotective Efficacy and Therapeutic Window of the High-Affinity N-Methyl-D-aspartate Antagonist Conantokin-G: In Vitro (Primary Cerebellar Neurons) and In Vivo (Rat Model of Transient Focal Brain Ischemia) Studies J. Pharmacol. Exp. Ther., July 1, 2000; 294(1): 378 - 386. [Abstract] [Full Text]
|
|
|
|
|
|
J. Oliveira-Filho, H. Ay, P. W. Schaefer, F. S. Buonanno, Y. Chang, R. G. Gonzalez, and W. J. Koroshetz Diffusion-Weighted Magnetic Resonance Imaging Identifies the "Clinically Relevant" Small-Penetrator Infarcts Arch Neurol, July 1, 2000; 57(7): 1009 - 1014. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Biondi, C. Oppenheim, E. Vivas, A. Casasco, T. Lalam, N. Sourour, L. L. Jean, D. Dormont, and C. Marsault Cerebral Aneurysms Treated by Guglielmi Detachable Coils: Evaluation with Diffusion-weighted MR Imaging AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 957 - 963. [Abstract] [Full Text]
|
|
|
|
|
|
M. G. Lansberg, G. W. Albers, C. Beaulieu, and M. P. Marks Comparison of diffusion-weighted MRI and CT in acute stroke Neurology, April 25, 2000; 54(8): 1557 - 1561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Britt, J. E. Heiserman, R. M. Snider, H. A. Shill, C. R. Bird, and R. C. Wallace Incidence of Postangiographic Abnormalities Revealed by Diffusion-Weighted MR Imaging AJNR Am. J. Neuroradiol., January 1, 2000; 21(1): 55 - 59. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, J. Oliveira-Filho, F. S. Buonanno, M. Ezzeddine, P. W. Schaefer, G. Rordorf, L. H. Schwamm, R. G. Gonzalez, and W. J. Koroshetz Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source Stroke, December 1, 1999; 30(12): 2644 - 2650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Q. Yang, B. M. Tress, P. A. Barber, P. M. Desmond, D. G. Darby, R. P. Gerraty, T. Li, and S. M. Davis Serial Study of Apparent Diffusion Coefficient and Anisotropy in Patients With Acute Stroke Stroke, November 1, 1999; 30(11): 2382 - 2390. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schlaug, A. Benfield, A. E. Baird, B. Siewert, K. O. Lovblad, R. A. Parker, R. R. Edelman, and S. Warach The ischemic penumbra: Operationally defined by diffusion and perfusion MRI Neurology, October 22, 1999; 53(7): 1528 - 1528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Seitz, N. P. Azari, U. Knorr, F. Binkofski, H. Herzog, and H.-J. Freund The Role of Diaschisis in Stroke Recovery Stroke, September 1, 1999; 30(9): 1844 - 1850. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, H.-J. Wittsack, F. Wenserski, M. Siebler, R. J. Seitz, U. Modder, and H.-J. Freund Diffusion- and Perfusion-Weighted MRI : The DWI/PWI Mismatch Region in Acute Stroke Stroke, August 1, 1999; 30(8): 1591 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-J. Wittsack, A. Ritzl, G. R. Fink, F. Wenserski, M. Siebler, R. J. Seitz, U. Modder, and H.-J. Freund MR Imaging in Acute Stroke: Diffusion-weighted and Perfusion Imaging Parameters for Predicting Infarct Size Radiology, February 1, 2002; 222(2): 397 - 403. [Abstract] [Full Text] [PDF]
|
|