title: Perfusion-Weighted MRI Parameters for Prediction of Early Progressive Infarction in Middle Cerebral Artery Occlusion.
abstract: OBJECTIVE
  Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI.
  
  
  METHODS
  We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ≥2 points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI.
  
  
  RESULTS
  Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI.
  
  
  CONCLUSIONS
  The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Neurology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Yerim
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Seong Rim
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Yang
keywords: Acute ischemic stroke; Cerebral blood volume; Hemodynamic failure; Magnetic resonance imaging; Middle cerebral artery occlusion