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Acute Ischemic Stroke: Predictive Value of 2D Phase-Contrast MR Angiography—Serial Study with Combined Diffusion and Perfusion MR Imaging¹

¹ From the Depts of Clinical Radiology (Y.L., J.O.K., R.L.V., A.K., S.S., H.J.A.) and Neurology (J.N.), Kuopio Univ Hosp, PO Box 1777, FIN-70211 Kuopio, Finland; Dept of Radiology, Mikkeli Central Hosp, Finland (J.O.K.); and Functional Brain Imaging Unit, Helsinki Brain Research Ctr, Finland (H.J.A.). From the 2002 RSNA scientific assembly. Received Apr 10, 2003; revision requested Jun 27; revision received Aug 7; accepted Oct 1. Supported by Kuopio University Hospital (EVO funding 307/97, 21/98, and 5063504), Radiological Society of Finland, Academy of Finland, Sigrid Juselius Foundation, Instrumentarium Science Foundation, Aarne Koskelo Foundation, and Paavo Nurmi Foundation. Address correspondence to Y.L. (e-mail: yawu.liu@kuh.fi).

PURPOSE: To evaluate phase-contrast magnetic resonance (MR) angiography and diffusion- and perfusion-weighted imaging in predicting evolution of infarction and clinical outcome.

MATERIALS AND METHODS: Phase-contrast angiographic and diffusion-weighted images obtained 1 and 2 days after acute middle cerebral artery (MCA) stroke were assessed in 43 patients; 39 underwent perfusion-weighted imaging on day 1. Follow-up phase-contrast angiographic and T2-weighted images (n = 38) were obtained on day 8. Clinical outcome was assessed at 3 months. Patients were assigned to three groups according to angiographic findings on day 1: group 1, absence of flow in proximal MCA (M1 segment); group 2, internal carotid artery (ICA) occlusion with collateral M1 flow; group 3, flow in ICA and M1. Differences in lesion volumes on diffusion- and perfusion-weighted maps among groups were compared with one-way analysis of variance with Tukey post hoc multiple comparisons.

RESULTS: Patients in group 1 had significantly larger infarct growth, volumes of hypoperfusion on relative cerebral blood volume (rCBV) and relative cerebral blood flow maps, and initial and final infarct volumes than did other patients (P < .05). Initial perfusion deficits on mean transit time maps were significantly (P = .002) larger in group 2 than in group 3, but there were no significant differences in infarct growth (P = .977), final infarct volume on day 8 (P = .947), and clinical outcome (P = .969). Absence of M1 flow on day 1 was significantly associated with unfavorable clinical outcome (modified Rankin score 3) at 3 months (P = .010, ² test). Discriminant analysis revealed that rCBV maps alone and combination of diffusion-weighted imaging and MR angiography yielded the highest accuracy in predicting an unfavorable clinical outcome.

CONCLUSION: Phase-contrast MR angiography can provide complementary information to that with diffusion- and perfusion- weighted imaging in predicting the outcome of patients with acute stroke.

© RSNA, 2004

Index terms: Blood vessels, MR, 17.12142, 17.12144 • Brain, infarction, 13.78 • Brain, MR, 13.121411, 13.121416, 13.12142, 13.12143, 13.12144 • Magnetic resonance (MR), diffusion study, 13.12144 • Magnetic resonance (MR), perfusion study, 13.12144 • Magnetic resonance (MR), phase imaging, 13.12149

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