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(Radiology. 2000;217:886-894.)
© RSNA, 2000

Neuroradiology

Combined Perfusion- and Diffusion-weighted MR Imaging in Acute Ischemic Stroke during the 1st Week: A Longitudinal Study1

Jari O. Karonen, MD, Yawu Liu, MD, Ritva L. Vanninen, MD, PhD, Leif Østergaard, MD, MSc, P. L. Kaarina Partanen, MD, PhD, Pauli A. Vainio, PhL, Esko J. Vanninen, MD, PhD, Juho Nuutinen, MD, Reina Roivainen, MD, PhD, Seppo Soimakallio, MD, PhD, Jyrki T. Kuikka, PhD and Hannu J. Aronen, MD, PhD

1 From the Depts of Clinical Radiology (J.O.K., Y.L., R.L.V., P.L.K.P., P.A.V., S.S., H.J.A.), Neurology (J.N., R.R.), and Clinical Physiology and Nuclear Medicine (E.J.V., J.T.K.), Kuopio University Hospital, Puijonlaaksontie 2, FIN-70210 Kuopio, Finland; Dept of Neuroradiology, Aarhus University Hospitals, Denmark (L.Ø.); Haage Neurological Research Center, Helsinki, Finland (R.R.); Dept of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio (J.T.K.); and Dept of Radiology, Helsinki University Central Hospital (H.J.A.). From the 1999 RSNA scientific assembly. Received Dec 7, 1999; revision requested Jan 21, 2000; revision received Apr 7; accepted Apr 20. Supported in part by the Kuopio University Hospital (EVO funding 307/97 and 21/98; J.O.K., Y.L., J.N., H.J.A.), Radiological Society of Finland (J.O.K., Y.L.), Instrumentarium Science Foundation (J.O.K., Y.L.), Aarne Koskelo Foundation (J.O.K.), Paavo Nurmi Foundation (H.J.A.), Sigrid Juselius Foundation (J.O.K., Y.L., H.J.A.), and Academy of Finland (H.J.A.). Address correspondence to J.O.K. (e-mail: jari.karonen@kuh.fi).

PURPOSE: To compare findings with different magnetic resonance (MR) perfusion maps in acute ischemic stroke.

MATERIALS AND METHODS: Combined diffusion-weighted (DW) and perfusion-weighted (PW) MR imaging was performed in 49 patients with acute (<24 hours) stroke, on the 1st and 2nd days and 1 week after stroke. Volumes of hypoperfused tissue on maps of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), and mean transit time (MTT) were compared with the volume of infarcted tissue at DW imaging.

RESULTS: The mean infarct volume increased from 41 to 65 cm3 between the 1st and 2nd days (P < .001; n = 49). On the 1st day, all perfusion maps on average showed hypoperfusion lesions larger than the infarct at DW imaging (P < .001; n = 49). MTT maps showed significantly (P < .001) larger hypoperfusion lesions than did rCBF maps, which showed significantly (P < .001) larger hypoperfusion lesions than did rCBV maps. The sizes of the initial perfusion-diffusion mismatches correlated significantly with the extent of infarct growth (0.479 < r < 0.657; P <= .001). The hypoperfusion volume on the initial rCBV maps correlated best with the final infarct size at 1 week (r = 0.891; P < .001).

CONCLUSION: Combined DW and PW imaging is a powerful tool in evaluating the hemodynamics of acute ischemic stroke.

Index terms: Blood vessels, MR, 17.12142, 17.12144 • Brain, diffusion, 13.12144 • Brain, infarction, 13.78 • Brain, MR, 13.12144 • Brain, perfusion, 13.12144 • Magnetic resonance (MR), diffusion study, 13.12144 • Magnetic resonance (MR), perfusion study, 13.12144 • Magnetic resonance (MR), vascular studies, 13.12144




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