Persistent infarct hyperintensity on diffusion-weighted imaging late after stroke indicates heterogeneous, delayed, infarct evolution

Some infarcts have persistently hyperintense areas on diffusion-weighted MRI (DWI) even at 1 month after stroke, whereas others have become isointense to normal brain. We hypothesized that late DWI hyperintensity reflected different infarct evolution compared with areas that were isointense by 1 mon...

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Bibliographic Details
Published in:Stroke (1970) 2006-06, Vol.37 (6), p.1418-1423
Main Authors: RIVERS, Carly S, WARDLAW, Joanna M, ARMITAGE, Paul A, BASTIN, Mark E, CARPENTER, Trevor K, CVORO, Vera, HAND, Peter J, DENNIS, Martin S
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Brain - pathology
Brain - physiopathology
Cerebral Infarction - diagnosis
Cerebrovascular Circulation
Diffusion Magnetic Resonance Imaging
Female
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Nervous system
Nervous system (semeiology, syndromes)
Neurology
Prospective Studies
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Stroke - diagnosis
Stroke - physiopathology
Time Factors
Vascular diseases and vascular malformations of the nervous system
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Summary:Some infarcts have persistently hyperintense areas on diffusion-weighted MRI (DWI) even at 1 month after stroke, whereas others have become isointense to normal brain. We hypothesized that late DWI hyperintensity reflected different infarct evolution compared with areas that were isointense by 1 month. We recruited patients prospectively with ischemic stroke, performed DWI and perfusion-weighted MRI (PWI) on admission, at 5 days, 14 days, and 1 month after stroke, and assessed functional outcome at 3 months (Rankin Scale). Patient characteristics and DWI/PWI values were compared for patients with or without "still hyperintense" infarct areas on 1-month DWI. Among 42 patients, 27 (64%) had "still hyperintense" infarct regions at 1 month, mostly in white matter. Patients with "still hyperintense" regions at 1 month had lower baseline apparent diffusion coefficient ratio (ADCr; mean+/-SD 0.76+/-0.12 versus 0.85+/-0.12; hyperintense versus isointense; P
ISSN:0039-2499
1524-4628
DOI:10.1161/01.STR.0000221294.90068.c4