Fluid-attenuated inversion recovery and diffusion- and perfusion-weighted MRI abnormalities in 117 consecutive patients with stroke symptoms

C J Perkins, E Kahya, C T Roque, P E Roche, G C Newman
Stroke; a Journal of Cerebral Circulation 2001 December 1, 32 (12): 2774-81

BACKGROUND AND PURPOSE: Diffusion-weighted MRI (DWI) is highly sensitive to early cerebral ischemia, but its dependence on lesion location, acuity, and etiology remains unknown. Furthermore, although a marked perfusion-weighted MRI (PWI)-DWI mismatch may exist in a subset of acute strokes, the frequency and distribution of these mismatches have never been methodically characterized in an unselected population. To address these 2 issues, we evaluated echo-planar imaging in 117 consecutive patients with signs and symptoms of acute stroke.

METHODS: Clinical diagnoses were determined by chart review. Fluid-attenuated inversion recovery (FLAIR), DWI, and PWI sequences were scored for lesion acuity, neuroanatomy, and vascular territory. Lesion and PWI-DWI mismatch volumes were determined by image analysis.

RESULTS: DWI was more sensitive than was FLAIR for the detection of stroke for all subtypes in all anatomic distributions and at all tested time intervals. Although DWI exhibited its greatest benefit over FLAIR during the first 6 hours, it was still superior to FLAIR even after 24 hours. PWI abnormalities were detected in 49% of patients with DWI abnormalities. In the majority of these cases, the PWI-DWI mismatch was substantially larger than the DWI lesion itself. Both the largest DWI lesion volumes and the largest mismatch volumes occurred in patients with carotid disease.

CONCLUSIONS: DWI nearly doubles the likelihood of detecting acute ischemic stroke lesions compared with FLAIR for all etiologies and in all anatomic locations. In the hyperacute period (0 to 6 hours), DWI more than triples the likelihood of acute-stroke detection over FLAIR. PWI reveals a measurable mismatch compared with DWI nearly 50% of the time; and in more than half of these patients, the ratio of the volume of the PWI lesion to the DWI lesion is several times larger than the core ischemic lesion itself. In the final analysis, approximately one fourth of all stroke patients present with a large volume of potentially salvageable tissue at risk for infarction.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"