[What stroke MRI provides to us].
Goal of initial imaging study for acute-stage ischemic stroke are to detect focal lesion accurately and to assist the therapeutic decision. With the goal in mind, we investigated feasibilities of MRI for acute-stage ischemic stroke. Firstly, we assessed whether diffusion weighted images (DWI) raised diagnostic accuracy for acute-stage ischemic stroke. We investigated how DWI study changes the diagnosis for the patients with neurological symptom in emergency room. Out of 164 patients who visit the emergency room with neurological symptom, sensitivity, specificity and efficiency for ischemic stroke diagnosis before DWI study were 0.87, 0.85 and 0.89 respectively. DWI raised them to 0.99, 0.98 and 0.99. These result proves feasibility of DWI on diagnosis of acute-stage ischemic stoke. Secondly, we assess whether DWI and perfusion imaging (PI) can provide any information about fate of acute ischemic lesion. We compared the relationships between DWI and PI parameters (ADC, rCBF, MTT, rCBV) and tissue outcome (infracted or survived). In patients with successful recanalization, best predictor was ADC and the cut-off value was 0.90 against contra-lateral hemisphere. In patients without recanalization, rCBF at 0.66 against contra-lateral hemisphere predicted the pathological fate most accurately. This simple guidepost can be help therapeutic decision of acute-stage stroke.
Igarashi
Hironaka
H
Center for Human Brain Science, Brain Research Institute, University of Niigata.
D000208:Acute Disease; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D020521:Stroke / Q000175:diagnosis*