title: Early new diffusion-weighted imaging lesions appear more often in stroke patients with a multiple territory lesion pattern.
abstract: OBJECTIVE
  New diffusion-weighted imaging (DWI) lesions are common in patients with acute ischemic stroke. They are associated with an initial nonsingle lesion pattern. Previous studies have not analyzed this association in detail. We differentiated nonsingle lesions in 1 vascular supply territory only (scattered lesion pattern) from nonsingle lesions in ≥2 vascular supply territory (multiple territory lesion -pattern).
  
  
  METHODS
  Patients with an acute ischemic stroke underwent 3 MRI (3T) examinations: on admission, on the following day, and 4 to 7 days after symptom onset. First, DWI lesions were delineated manually by raters blinded to clinical details. Second, DWI images were coregistered and analyzed visually for new hyperintensities. The initial lesion pattern was categorized as single, scattered, or multiple territory.
  
  
  RESULTS
  Of 340 patients enrolled, 43% had a single lesion pattern, 40% had a scattered lesion pattern, and 17% had a multiple territory lesion pattern. In multivariable analysis, the categorical variable lesion pattern was independently associated with new DWI lesions (odds ratio multiple territory lesion pattern, 3.64 [95% confidence interval, 1.75-7.58]; odds ratio scattered lesion pattern, 1.96 [95% confidence interval, 1.09-3.56]). Patients with multiple territory lesion pattern had significantly more often diabetes mellitus, and their new lesions were more often located remotely from the initial area of hypoperfusion compared with patients with scattered lesion pattern.
  
  
  CONCLUSIONS
  Lesion pattern on initial image is an independent risk factor for new DWI lesions. The risk for new DWI lesions is highest in patients with multiple territory lesion pattern.
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, Benjamin Franklin Campus, Berlin, Germany. tim-bastian.braemswig@charite.de
authors.forename: Tim Bastian
authors.initials: TB
authors.lastname: Braemswig
authors.forename: Tatiana
authors.initials: T
authors.lastname: Usnich
authors.forename: Fredrik N
authors.initials: FN
authors.lastname: Albach
authors.forename: Peter
authors.initials: P
authors.lastname: Brunecker
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Jan F
authors.initials: JF
authors.lastname: Scheitz
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology*; D002544:Cerebral Infarction / Q000145:classification / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology*; D013997:Time Factors
keywords: diffusion-weighted imaging; magnetic resonance imaging; new DWI lesions; silent brain infarction; stroke