• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Neurol Neurosurg Psychiatry. Sep 2005; 76(9): 1222–1228.
PMCID: PMC1739781

Specific DWI lesion patterns predict prognosis after acute ischaemic stroke within the MCA territory

Abstract

Background: Apart from diffusion-weighted imaging (DWI) lesion volume and diffusion–perfusion mismatching, there is limited information about neuroradiological predictors of early prognosis after an ischaemic stroke. This study sought to identify specific DWI lesion patterns that would help prediction of early prognosis of three different endpoints: unstable hospital course, recurrence of stroke, and poor neurological outcome at 90 days after ischaemic stroke.

Methods: A total of 426 patients with acute cerebral infarcts within the middle cerebral artery territory were prospectively studied. Using the DWI data the patients were divided into six groups (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts), and any recurrent strokes and prognosis over the following 90 days were recorded.

Results: DWI lesion pattern was a stronger and more consistent independent outcome predictor than DWI lesion volume. The specific DWI lesion patterns associated with each endpoint differed. An unstable hospital course was frequently observed in patients with internal border zone infarcts, whereas recurrent strokes after the index stroke were commoner in those who had small superficial infarcts (p<0.05 in both cases). Similarly, poor outcome after stroke was associated with older age, severe neurological deficits at admission, and a DWI lesion pattern showing internal border zone infarcts.

Conclusions: The results of the present study indicate that the DWI lesion pattern may help in recognition of the likely differences in the early prognostic endpoints after ischaemic stroke, and DWI analysis may guide targeted interventions to prevent negative outcomes.

Full Text

The Full Text of this article is available as a PDF (157K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Lövblad KO, Baird AE, Schlaug G, Benfield A, Siewert B, Voetsch B, Connor A, Burzynski C, Edelman RR, Warach S. Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol. 1997 Aug;42(2):164–170. [PubMed]
  • Tong DC, Yenari MA, Albers GW, O'Brien M, Marks MP, Moseley ME. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology. 1998 Apr;50(4):864–870. [PubMed]
  • Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology. 1998 Aug;51(2):418–426. [PubMed]
  • Beaulieu C, de Crespigny A, Tong DC, Moseley ME, Albers GW, Marks MP. Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: evolution of lesion volume and correlation with clinical outcome. Ann Neurol. 1999 Oct;46(4):568–578. [PubMed]
  • Baird AE, Dambrosia J, Janket S, Eichbaum Q, Chaves C, Silver B, Barber PA, Parsons M, Darby D, Davis S, et al. A three-item scale for the early prediction of stroke recovery. Lancet. 2001 Jun 30;357(9274):2095–2099. [PubMed]
  • Thijs VN, Lansberg MG, Beaulieu C, Marks MP, Moseley ME, Albers GW. Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke. 2000 Nov;31(11):2597–2602. [PubMed]
  • Wardlaw JM, Keir SL, Bastin ME, Armitage PA, Rana AK. Is diffusion imaging appearance an independent predictor of outcome after ischemic stroke? Neurology. 2002 Nov 12;59(9):1381–1387. [PubMed]
  • Baird AE, Lövblad KO, Schlaug G, Edelman RR, Warach S. Multiple acute stroke syndrome: marker of embolic disease? Neurology. 2000 Feb 8;54(3):674–678. [PubMed]
  • Gandolfo C, Del Sette M, Finocchi C, Calautti C, Loeb C. Internal borderzone infarction in patients with ischemic stroke. Cerebrovasc Dis. 1998 Sep-Oct;8(5):255–258. [PubMed]
  • Lee Phil Hyu, Bang Oh Young, Oh Se Ho, Joo In Soo, Huh Kyoon. Subcortical white matter infarcts: comparison of superficial perforating artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging. Stroke. 2003 Nov;34(11):2630–2635. [PubMed]
  • Bang Oh Young, Lee Phil Hyu, Joo Sung Yeol, Lee Jin Soo, Joo In Soo, Huh Kyoon. Frequency and mechanisms of stroke recurrence after cryptogenic stroke. Ann Neurol. 2003 Aug;54(2):227–234. [PubMed]
  • Heinsius T, Bogousslavsky J, Van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology. 1998 Feb;50(2):341–350. [PubMed]
  • Kimura K, Minematsu K, Koga M, Arakawa R, Yasaka M, Yamagami H, Nagatsuka K, Naritomi H, Yamaguchi T. Microembolic signals and diffusion-weighted MR imaging abnormalities in acute ischemic stroke. AJNR Am J Neuroradiol. 2001 Jun-Jul;22(6):1037–1042. [PubMed]
  • Mull M, Schwarz M, Thron A. Cerebral hemispheric low-flow infarcts in arterial occlusive disease. Lesion patterns and angiomorphological conditions. Stroke. 1997 Jan;28(1):118–123. [PubMed]
  • van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke. 1998 Sep;29(9):1783–1790. [PubMed]
  • Baird AE, Benfield A, Schlaug G, Siewert B, Lövblad KO, Edelman RR, Warach S. Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol. 1997 May;41(5):581–589. [PubMed]
  • Garcia JH, Lassen NA, Weiller C, Sperling B, Nakagawara J. Ischemic stroke and incomplete infarction. Stroke. 1996 Apr;27(4):761–765. [PubMed]
  • Lee PH, Oh S-H, Bang OY, Joo S-Y, Joo IS, Huh K. Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease. Neurology. 2004 Apr 27;62(8):1291–1296. [PubMed]
  • Petty GW, Brown RD, Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes : a population-based study of functional outcome, survival, and recurrence. Stroke. 2000 May;31(5):1062–1068. [PubMed]
  • Yamamoto H, Bogousslavsky J, van Melle G. Different predictors of neurological worsening in different causes of stroke. Arch Neurol. 1998 Apr;55(4):481–486. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...