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(Stroke. 1998;29:1778-1782.)
© 1998 American Heart Association, Inc.

Original Contributions

Time Course of ADC_w Changes in Ischemic Stroke: Beyond the Human Eye!

V. Nagesh, PhD; K. M. A. Welch, MD; J. P. Windham, PhD; S. Patel, MD; S. R. Levine, MD; D. Hearshen, PhD; D. Peck, MS; K. Robbins; L. D'Olhaberriague, MD, PhD; H. Soltanian-Zadeh, PhD; M. D. Boska, PhD

From the Departments of Neurology (V.N., K.M.A.W., S.R.L., L.D'O., M.D.B.) and Diagnostic Radiology (J.P.W., S.P., D.H., D.P., K.R., H.S.-Z.), Nuclear Magnetic Resonance and Stroke Research Centers, Henry Ford Health Sciences Center, Detroit Campus of Case Western Reserve University, Detroit, Mich; and Department of Electrical and Computer Engineering, University of Tehran, Tehran, Iran (H.S.-Z.).

Correspondence to Dr K.M.A Welch, NMR Research Center, Department of Neurology (K-11), Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202-2689. E-mail cwmru{at}neuro.hfh.edu

Background and Purpose—Using newly developed computerized image analysis, we studied the heterogeneity of apparent diffusion coefficient of water (ADC_w) values in human ischemic stroke within 10 hours of onset.

Methods—Echo-planar trace diffusion-weighted images from 9 patients with focal cortical ischemic stroke were obtained within 10 hours of symptom onset. An Iterative Self-Organizing Data Analysis (ISODATA) clustering algorithm was implemented to segment different tissue types with a series of DW images. ADC_w maps were calculated from 4 DW images on a pixel-by-pixel basis. The segmented zones within the lesion were characterized as low, pseudonormal, or high, expressed as a ratio of the mean±SD of ADC_w of contralateral noninvolved tissue.

Results—The average ADC_w in the ischemic stroke region within 10 hours of onset was significantly depressed compared with homologous contralateral tissue (626.6±76.8 versus 842.9±60.4x10^-6 mm²/s; P<0.0001). Nevertheless, ISODATA segmentation yielded multiple zones within the stroke region that were characterized as low, pseudonormal, and high. The mean proportion of low:pseudonormal:high was 72%:20%:8%.

Conclusions—Despite low average ADC_w, computer-assisted segmentation of DW MRI detected heterogeneous zones within ischemic lesions corresponding to low, pseudonormal, and high ADC_w not visible to the human eye. This supports acute elevation of ADC_w in human ischemic stroke and, accordingly, different temporal rates of tissue evolution toward infarction.

Key Words: cerebral ischemia, focal • magnetic resonance imaging • signal processing, computer assisted • stroke, acute

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