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(Stroke. 2000;31:2901.)
© 2000 American Heart Association, Inc.

Original Contribution

Failure to Demonstrate Peri-Infarct Depolarizations by Repetitive MR Diffusion Imaging in Acute Human Stroke

Tobias Back, MD; Jochen G. Hirsch, PhD; Kristina Szabo, MD Achim Gass, MD

From the Department of Neurology, Klinikum Mannheim, Ruprecht Karls University Heidelberg, and Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University Munich (Germany).

Correspondence and reprint requests to Dr Tobias Back, Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians-University Munich, Marchioninistrasse 15, D-81377 Munich, Germany. E-mail Tobias.Back{at}lrz.uni-muenchen.de

Background and Purpose—Peri-infarct depolarizations (PIDs) have been demonstrated with diffusion-weighted MRI (DWI) in experimental stroke and are regarded as an important mechanism of ischemic injury. We tested the hypothesis that PIDs are of relevance for the early enlargement of human brain infarcts.

Methods—Ten stroke patients were investigated by repetitive imaging of the apparent diffusion coefficient (ADC) in the acute phase (7 patients) or subacute phase (3 patients) of developing cortical infarction. In each patient, 20 ADC maps were obtained from serially measured echo-planar DWI (interval of 45 seconds). Data analysis focused on the potential spatial and temporal ADC changes, including structured qualitative analysis, calculation of subtraction images, serial analysis of regions of interest positioned in the infarct core and border, and calculation of hemispheric lesion areas, depending on various ADC thresholds ranging between 0 and 800 µm²/s.

Results—Data analysis was unable to disclose any time-dependent changes in ADC that would resemble PID. In ischemic regions, the ADC reduction significantly progressed from the infarct border (555±96 µm²/s) to the infarct core (431±104 µm²/s, P<0.01).

Conclusions—By using an MRI protocol with high temporal resolution and elaborated postprocessing, we were unable to demonstrate a pattern of diffusion changes that would be indicative of PID in human stroke. Experimental infarction and human stroke may differ in the detectability of PID.

Key Words: magnetic resonance imaging, diffusion-weighted • spreading cortical depression • stroke

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