title: Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M(1-2) segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis.
  
  
  METHODS
  Initial infarct volume (V(DWI-I) ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum V(DWI-I) still associated with a good clinical outcome, the patients were divided into two groups (V(DWI-I) < or =70 ml and >70 ml).
  
  
  RESULTS
  V(DWI-I) ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a V(DWI-I) < or =70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a V(DWI-I) >70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026).
  
  
  CONCLUSIONS
  Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a V(DWI-I) < or =70 ml had a significantly better outcome.
authors.affiliation: Stroke Center, Department of Neurology, University Hospital, IP Pavlova 6, 775 20, Olomouc, Czech Republic. daniel.sanak@centrum.cz
authors.forename: Daniel
authors.initials: D
authors.lastname: Sanák
authors.forename: Vladimír
authors.initials: V
authors.lastname: Nosál'
authors.forename: David
authors.initials: D
authors.lastname: Horák
authors.forename: Andrea
authors.initials: A
authors.lastname: Bártková
authors.forename: Kamil
authors.initials: K
authors.lastname: Zelenák
authors.forename: Roman
authors.initials: R
authors.lastname: Herzig
authors.forename: Jirí
authors.initials: J
authors.lastname: Bucil
authors.forename: David
authors.initials: D
authors.lastname: Skoloudík
authors.forename: Stanislav
authors.initials: S
authors.lastname: Burval
authors.forename: Viera
authors.initials: V
authors.lastname: Cisariková
authors.forename: Ivanka
authors.initials: I
authors.lastname: Vlachová
authors.forename: Martin
authors.initials: M
authors.lastname: Köcher
authors.forename: Jana
authors.initials: J
authors.lastname: Zapletalová
authors.forename: Egon
authors.initials: E
authors.lastname: Kurca
authors.forename: Petr
authors.initials: P
authors.lastname: Kanovský
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome