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.

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

“…CT has been used in similar reports that have evaluated intracranial and cervical stenosis in hyperacute brain infarcts 11,30 . Although the use of diffusion-weighted imaging has been advocated to be more accurate in detecting brain ischemia and exploring stroke mechanisms, this technique is not included as part of the routine workup in patients with hyperacute stroke 12,29,31 . Brain CT is preferred in our institutional protocol for evaluating hyperacute brain ischemia in the anterior intracranial circulation.…”

Non-conventional risk factors were associated with infarct patterns in ischemic stroke

“…DWI lesion pattern) were seldom studied, or limited to specific stroke subtypes [17,16,18,23]. Nonetheless, it would appear that DWI lesion pattern alone may also have an important prognostic value after ischemic stroke [9]. In this study, we found hs-CRP levels on admission and the presence of metabolic abnormalities, as well as several conventional risk factors to be significantly yet variably associated with the pattern of infarcts on DWI.…”

“…Several studies have shown that topographic patterns on DWI may provide early clues to stroke mechanism, provide prognostic information, and guide therapeutic options in acute ischemic stroke patients [1,3,[7][8][9]. Beyond the relationship between infarct pattern and stroke mechanism, there is limited information about the association between clinical factors and infarct pattern in ischemic stroke, particularly emerging indices of vascular risk.…”

Comparative Study of the Prognosis of Ischemic Cerebral Stroke Subtypes

“…Anterior choroidal artery infarctions may be more likely to progress in the first few days after stroke than other subtypes [27,28]. There are limited and conflicting data regarding border zone infarcts and outcome [29,30]. The size of acute infarction on neuroimaging studies may be used to estimate stroke outcome [31].…”