TY - JOUR
T1 - Early evolution of deficits in acute ischemic stroke
T2 - Mean transit time, relative blood volume, and relative blood flow
AU - Phan, Thanh G.
AU - Huston, John
AU - Campeau, Norbert G.
AU - Brown, Robert D.
AU - Fulgham, Jimmy R.
AU - Wijdicks, Eelco F.M.
PY - 2002
Y1 - 2002
N2 - The objective of this prospective pilot study was to determine the evolution of imaging characteristics of perfusion-weighted imaging (PWI), including mean transit time (MTT), relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), diffusion-weighted imaging (DWI), and magnetic resonance (MR) angiography in the first 48 hours after an acute cerebral infarction. In 5 patients with suspected middle cerebral artery (MCA) territory infarction, images were obtained on 4 occasions during the first 48 hours (6-10 hours, 15-18 hours, 22-24 hours, and 48 hours) by an imaging protocol that included echoplanar DWI, PWI, and MR angiography. No patients received thrombolytic or neuroprotective agents. Four of the 5 patients had MCA occlusions on the initial MR angiogram. Presumably, the MCA had recanalized in 1 patient before the first MR angiogram. Recanalization of the MCA was observed by the second scan in 1 patient and by the fourth scan in the remaining 3 patients. The mean MTT volume deficit was greater than the DWI volume (mismatch) until the final MR examination at 48 hours. The mean rCBV and rCBF volumes were larger than the DWI volume (mismatch) on the first MR examination but were smaller on the second and subsequent examinations. Decrease in the size of the MTT volume before recanalization of the MCA was most likely due to opening of collateral channels, but the greatest decrease in the size of the MTT volume occurred with recanalization of the MCA. All patients had progressive enlargement of the abnormal DWI volume. The MR changes following acute cerebral infarction are dynamic, with the volume of the diffusion abnormality nearly doubling between 6 to 10 hours and 48 hours. The volume of the acute MTT abnormality (6-10 hours) is approximately twice the size of the diffusion abnormality at 48 hours. The volume of the rCBV and rCBF between 6 and 10 hours after ictus is a good reflection of the diffusion abnormality at 48 hours.
AB - The objective of this prospective pilot study was to determine the evolution of imaging characteristics of perfusion-weighted imaging (PWI), including mean transit time (MTT), relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), diffusion-weighted imaging (DWI), and magnetic resonance (MR) angiography in the first 48 hours after an acute cerebral infarction. In 5 patients with suspected middle cerebral artery (MCA) territory infarction, images were obtained on 4 occasions during the first 48 hours (6-10 hours, 15-18 hours, 22-24 hours, and 48 hours) by an imaging protocol that included echoplanar DWI, PWI, and MR angiography. No patients received thrombolytic or neuroprotective agents. Four of the 5 patients had MCA occlusions on the initial MR angiogram. Presumably, the MCA had recanalized in 1 patient before the first MR angiogram. Recanalization of the MCA was observed by the second scan in 1 patient and by the fourth scan in the remaining 3 patients. The mean MTT volume deficit was greater than the DWI volume (mismatch) until the final MR examination at 48 hours. The mean rCBV and rCBF volumes were larger than the DWI volume (mismatch) on the first MR examination but were smaller on the second and subsequent examinations. Decrease in the size of the MTT volume before recanalization of the MCA was most likely due to opening of collateral channels, but the greatest decrease in the size of the MTT volume occurred with recanalization of the MCA. All patients had progressive enlargement of the abnormal DWI volume. The MR changes following acute cerebral infarction are dynamic, with the volume of the diffusion abnormality nearly doubling between 6 to 10 hours and 48 hours. The volume of the acute MTT abnormality (6-10 hours) is approximately twice the size of the diffusion abnormality at 48 hours. The volume of the rCBV and rCBF between 6 and 10 hours after ictus is a good reflection of the diffusion abnormality at 48 hours.
KW - Cerebral infarction
KW - Diffusion abnormality
KW - Ischemic stroke
KW - Magnetic resonance imaging
KW - Middle cerebral artery
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U2 - 10.1053/jscd.2002.126689
DO - 10.1053/jscd.2002.126689
M3 - Article
C2 - 17903859
AN - SCOPUS:0036522479
SN - 1052-3057
VL - 11
SP - 66
EP - 71
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 2
ER -