Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients

Jens Fiehler, Karina Knudsen, Thomas Kucinski, Stella Kidwell, Jeffry R. Alger, Götz Thomalla, Bernd Eckert, Oliver Wittkugel, Cornelius Weiller, Hermann Zeumer, Joachim Röther

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

Background and Purpose-We sought to describe the frequency of normalization of apparent diffusion coefficient (ADC) values that are decreased in hyperacute stroke and to identify characteristics of tissue demonstrating normalization. Methods-Sixty-eight acute ischemic stroke patients underwent MRI examination (including diffusion/perfusion imaging and MR angiography) within 6 hours (mean, 2.8 hours) after symptom onset, after 24 hours, and again 4 to 7 days later. Lesion volumes with decreased ADC and delayed time to peak in perfusion imaging were determined. In patients showing ADC normalization, volumes with ADC decrease graded as <50%, 50% to 60%, 60% to 70%, and 70% to 80% of the contralateral value were determined by thresholding. Patients were categorized as normalizers (demonstrating ADC normalization in >5 mL tissue with initially decreased ADC) or nonnormalizers (demonstrating ADC normalization in <5 mL tissue). Results-Fourteen patients (19.7%) were classified as normalizers. Eleven of 31 patients (35.5%) initially imaged <3 hours after stroke onset and 3 of 37 (7.5%) of those imaged 3 to 6 hours after onset were normalizers. ADC normalization occurred predominantly in the basal ganglia and white matter after thrombolytic therapy in patients with more distal vessel occlusions. All normalizers demonstrated at least partial tissue reperfusion. Tissue with more severe initial decrease in ADC was less likely to demonstrate normalization. Conclusions-ADC normalization is not a rare event in acute stroke after tissue reperfusion. Brain tissue with initially decreased ADC, especially within 3 hours after stroke onset, may include "tissue at risk".

Original languageEnglish (US)
Pages (from-to)514-519
Number of pages6
JournalStroke
Volume35
Issue number2
DOIs
StatePublished - Feb 2004
Externally publishedYes

Fingerprint

Stroke
Perfusion Imaging
Reperfusion
Thrombolytic Therapy
Basal Ganglia
Angiography
Brain

Keywords

  • Diffusion
  • Magnetic resonance imaging
  • Stroke, acute
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Fiehler, J., Knudsen, K., Kucinski, T., Kidwell, S., Alger, J. R., Thomalla, G., ... Röther, J. (2004). Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients. Stroke, 35(2), 514-519. https://doi.org/10.1161/01.STR.0000114873.28023.C2

Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients. / Fiehler, Jens; Knudsen, Karina; Kucinski, Thomas; Kidwell, Stella; Alger, Jeffry R.; Thomalla, Götz; Eckert, Bernd; Wittkugel, Oliver; Weiller, Cornelius; Zeumer, Hermann; Röther, Joachim.

In: Stroke, Vol. 35, No. 2, 02.2004, p. 514-519.

Research output: Contribution to journalArticle

Fiehler, J, Knudsen, K, Kucinski, T, Kidwell, S, Alger, JR, Thomalla, G, Eckert, B, Wittkugel, O, Weiller, C, Zeumer, H & Röther, J 2004, 'Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients', Stroke, vol. 35, no. 2, pp. 514-519. https://doi.org/10.1161/01.STR.0000114873.28023.C2
Fiehler, Jens ; Knudsen, Karina ; Kucinski, Thomas ; Kidwell, Stella ; Alger, Jeffry R. ; Thomalla, Götz ; Eckert, Bernd ; Wittkugel, Oliver ; Weiller, Cornelius ; Zeumer, Hermann ; Röther, Joachim. / Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients. In: Stroke. 2004 ; Vol. 35, No. 2. pp. 514-519.
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AU - Kucinski, Thomas

AU - Kidwell, Stella

AU - Alger, Jeffry R.

AU - Thomalla, Götz

AU - Eckert, Bernd

AU - Wittkugel, Oliver

AU - Weiller, Cornelius

AU - Zeumer, Hermann

AU - Röther, Joachim

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N2 - Background and Purpose-We sought to describe the frequency of normalization of apparent diffusion coefficient (ADC) values that are decreased in hyperacute stroke and to identify characteristics of tissue demonstrating normalization. Methods-Sixty-eight acute ischemic stroke patients underwent MRI examination (including diffusion/perfusion imaging and MR angiography) within 6 hours (mean, 2.8 hours) after symptom onset, after 24 hours, and again 4 to 7 days later. Lesion volumes with decreased ADC and delayed time to peak in perfusion imaging were determined. In patients showing ADC normalization, volumes with ADC decrease graded as <50%, 50% to 60%, 60% to 70%, and 70% to 80% of the contralateral value were determined by thresholding. Patients were categorized as normalizers (demonstrating ADC normalization in >5 mL tissue with initially decreased ADC) or nonnormalizers (demonstrating ADC normalization in <5 mL tissue). Results-Fourteen patients (19.7%) were classified as normalizers. Eleven of 31 patients (35.5%) initially imaged <3 hours after stroke onset and 3 of 37 (7.5%) of those imaged 3 to 6 hours after onset were normalizers. ADC normalization occurred predominantly in the basal ganglia and white matter after thrombolytic therapy in patients with more distal vessel occlusions. All normalizers demonstrated at least partial tissue reperfusion. Tissue with more severe initial decrease in ADC was less likely to demonstrate normalization. Conclusions-ADC normalization is not a rare event in acute stroke after tissue reperfusion. Brain tissue with initially decreased ADC, especially within 3 hours after stroke onset, may include "tissue at risk".

AB - Background and Purpose-We sought to describe the frequency of normalization of apparent diffusion coefficient (ADC) values that are decreased in hyperacute stroke and to identify characteristics of tissue demonstrating normalization. Methods-Sixty-eight acute ischemic stroke patients underwent MRI examination (including diffusion/perfusion imaging and MR angiography) within 6 hours (mean, 2.8 hours) after symptom onset, after 24 hours, and again 4 to 7 days later. Lesion volumes with decreased ADC and delayed time to peak in perfusion imaging were determined. In patients showing ADC normalization, volumes with ADC decrease graded as <50%, 50% to 60%, 60% to 70%, and 70% to 80% of the contralateral value were determined by thresholding. Patients were categorized as normalizers (demonstrating ADC normalization in >5 mL tissue with initially decreased ADC) or nonnormalizers (demonstrating ADC normalization in <5 mL tissue). Results-Fourteen patients (19.7%) were classified as normalizers. Eleven of 31 patients (35.5%) initially imaged <3 hours after stroke onset and 3 of 37 (7.5%) of those imaged 3 to 6 hours after onset were normalizers. ADC normalization occurred predominantly in the basal ganglia and white matter after thrombolytic therapy in patients with more distal vessel occlusions. All normalizers demonstrated at least partial tissue reperfusion. Tissue with more severe initial decrease in ADC was less likely to demonstrate normalization. Conclusions-ADC normalization is not a rare event in acute stroke after tissue reperfusion. Brain tissue with initially decreased ADC, especially within 3 hours after stroke onset, may include "tissue at risk".

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KW - Magnetic resonance imaging

KW - Stroke, acute

KW - Thrombolysis

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