Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration.
BACKGROUND
Current clinical tools to identify lacunar infarct patients at risk of deterioration are inadequate, and imaging techniques to predict fluctuation and deterioration would be of value. We sought to determine the occurrence of MRI perfusion-weighted imaging (PWI) abnormalities in lacunes, and whether they help predict clinical and radiological outcome.


METHODS
Patients with lacunar stroke or TIA were selected from a prospective MR imaging study. MRI was performed within 24 h of the event and follow-up imaging completed at 30 or 90 days. Baseline perfusion maps were qualitatively assessed and infarct volumes measured. Early clinical deterioration (NIHSS worsening of > or = 3 points within 72 h of event) and 90-day modified Rankin Scale score (mRS) were recorded.


RESULTS
Twenty-two patients were included. Fifteen (68.2%) had abnormal PWI at the site of the diffusion-weighted imaging lesion. Patients with abnormal PWI were more likely to have stroke than TIA as their index event (RR 2.2, 95% CI 0.9-5.2, p = 0.02). Early clinical deterioration occurred in 4 patients (18.2%), all of whom had abnormal PWI. PWI lesions were not associated with a higher 90-day NIHSS or mRS score, nor did they predict infarct volume growth.


CONCLUSIONS
MR-PWI abnormalities are seen in two thirds of lacunar infarcts, and are associated with stroke rather than TIA. Normal PWI identifies patients at low risk of early clinical deterioration.
Poppe
Alexandre Y
AY
Cerebrovascular Disease Centre, Department of Medicine, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Qué. H2L4M1, Canada. aypoppe@yahoo.ca
Coutts
Shelagh B
SB
Kosior
Jayme
J
Hill
Michael D
MD
O'Reilly
Christine M
CM
Demchuk
Andrew M
AM
D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors