The value of apparent diffusion coefficient maps in early cerebral ischemia.

BACKGROUND AND PURPOSE Prediction of the regions of the ischemic penumbra that are likely to progress to infarction is of great clinical interest. Whether lowered apparent diffusion coefficient (ADC) values were present in the ischemic penumbra of patients presenting with acute ischemic stroke and were specific to regions of the penumbra that proceeded to infarction was investigated. METHODS Nineteen patients with hemispheric stroke of less than 6 hours' onset and with acute scans showing a perfusion lesion greater than a diffusion lesion (ischemic penumbra) were studied. Scans also were performed subacutely (days 3 to 5) and at outcome (day 90). The outcome scan was used to identify regions of the penumbra that proceeded to infarction. RESULTS The ADC ratios were significantly reduced (P <.00001) in regions of the penumbra that progressed to infarction on the outcome scan compared with those that remained normal. In regions that showed transition to infarction, the mean ADC ratios were typically 0.75 to 0.90. CONCLUSION Intermediate ADC values are present in the ischemic penumbra and are indicative of tissue at risk of infarction.

[1]  M E Moseley,et al.  New magnetic resonance imaging methods for cerebrovascular disease: Emerging clinical applications , 2000, Annals of neurology.

[2]  T E Conturo,et al.  Differences between gray matter and white matter water diffusion in stroke: diffusion-tensor MR imaging in 12 patients. , 2000, Radiology.

[3]  S M Davis,et al.  Serial study of apparent diffusion coefficient and anisotropy in patients with acute stroke. , 1999, Stroke.

[4]  G. Schlaug,et al.  The ischemic penumbra: operationally defined by diffusion and perfusion MRI. , 1999, Neurology.

[5]  W. Koroshetz,et al.  Imaging stroke in progress: Magnetic resonance advances but computed tomography is poised for counterattack , 1999, Annals of neurology.

[6]  D. Okonkwo,et al.  An Intrathecal Bolus of Cyclosporin a before Injury Preserves Mitochondrial Integrity and Attenuates Axonal Disruption in Traumatic Brain Injury , 1999, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[7]  S M Davis,et al.  Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI , 1998, Neurology.

[8]  M. E. Moseley,et al.  Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke , 1998, Neurology.

[9]  J. Detre,et al.  Correlation of diffusion MRI and heat shock protein in a rat embolic stroke model , 1997, Journal of the Neurological Sciences.

[10]  R N Bryan,et al.  Absolute quantitation of diffusion constants in human stroke. , 1997, Stroke.

[11]  M. Goormastic,et al.  Durability of remission after ABMT for NHL: the importance of the 2-year evaluation point , 1997, Bone Marrow Transplantation.

[12]  T. L. Davis,et al.  Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. , 1996, Radiology.

[13]  David G. Norris,et al.  Evolution of Regional Changes in Apparent Diffusion Coefficient during Focal Ischemia of Rat Brain: The Relationship of Quantitative Diffusion NMR Imaging to Reduction in Cerebral Blood Flow and Metabolic Disturbances , 1995, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[14]  K. Hossmann.  Viability thresholds and the penumbra of focal ischemia , 1994, Annals of neurology.

[15]  K Minematsu,et al.  Reversible Focal Ischemic Injury Demonstrated by Diffusion‐Weighted Magnetic Resonance Imaging in Rats , 1992, Stroke.

[16]  Mark S. Cohen,et al.  Contrast agents and cerebral hemodynamics , 1991, Magnetic resonance in medicine.

[17]  J. E. Tanner,et al.  Spin diffusion measurements : spin echoes in the presence of a time-dependent field gradient , 1965 .