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  • Title: Predicting final infarct size using acute and subacute multiparametric MRI measurements in patients with ischemic stroke.
    Author: Lu M, Mitsias PD, Ewing JR, Soltanian-Zadeh H, Bagher-Ebadian H, Zhao Q, Oja-Tebbe N, Patel SC, Chopp M.
    Journal: J Magn Reson Imaging; 2005 May; 21(5):495-502. PubMed ID: 15834917.
    Abstract:
    PURPOSE: To identify early MRI characteristics of ischemic stroke that predict final infarct size three months poststroke. MATERIALS AND METHODS: Multiparametric MRI (multispin echo T2-weighted [T2W] imaging, T1-weighted [T1W] imaging, and diffusion-weighted imaging [DWI]) was performed acutely (<24 hours), subacutely (three to five days), and at three months. MRI was processed using maps of apparent diffusion coefficient (ADC), T2, and a self-organizing data analysis (ISODATA) technique. Analyses began with testing for individual MRI parameter effects, followed by multivariable modeling with assessment of predictive ability (R(2)) on final infarct size. RESULTS: A total of 45 patients were studied, 15 of whom were treated with tissue plasminogen activator (tPA) before acute MRI. The acute DWI and DWI-ISODATA mismatch lesion size, and the interactions of ADC, T2, and T2W imaging lesion with tPA remained in the final multivariable model (R(2) = 70%). A large acute DWI lesion or DWI < ISODATA lesion independently predicted increase in the final infract size, with predictive ability 68%. Predictive ability increased (R(2) = 83%) when subacute MRI parameters were included along with acute DWI, DWI-ISODATA mismatch, and acute T2W image lesion size by tPA treatment interaction. Subacute DWI > acute DWI lesion size predicted an increased final infarct size (P < 0.01). CONCLUSION: Acute-phase DWI and DWI-ISODATA mismatch strongly predict the final infarct size. An acute-to-subacute DWI lesion size change further increases the predictive ability of the model.
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