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Comparative Study
. 2013 Mar;44(3):681-5.
doi: 10.1161/STROKEAHA.111.000135. Epub 2013 Feb 6.

Early diffusion-weighted imaging and perfusion-weighted imaging lesion volumes forecast final infarct size in DEFUSE 2

Hayley M Wheeler  1 , Michael Mlynash, Manabu Inoue, Aaryani Tipirneni, John Liggins, Greg Zaharchuk, Matus Straka, Stephanie Kemp, Roland Bammer, Maarten G Lansberg, Gregory W Albers; DEFUSE 2 Investigators
Affiliations
Comparative Study

Early diffusion-weighted imaging and perfusion-weighted imaging lesion volumes forecast final infarct size in DEFUSE 2

Hayley M Wheeler et al. Stroke. 2013 Mar.

Abstract

Background and purpose: It is hypothesized that early diffusion-weighted imaging (DWI) lesions accurately estimate the size of the irreversibly injured core and thresholded perfusion-weighted imaging (PWI) lesions (time to maximum of tissue residue function [Tmax] >6 seconds) approximate the volume of critically hypoperfused tissue. With incomplete reperfusion, the union of baseline DWI and posttreatment PWI is hypothesized to predict infarct volume.

Methods: This is a substudy of Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2); all patients with technically adequate MRI scans at 3 time points were included. Baseline DWI and early follow-up PWI lesion volumes were determined by the RAPID software program. Final infarct volumes were assessed with 5-day fluid-attenuated inversion recovery and were corrected for edema. Reperfusion was defined on the basis of the reduction in PWI lesion volume between baseline and early follow-up MRI. DWI and PWI volumes were correlated with final infarct volumes.

Results: Seventy-three patients were eligible. Twenty-six patients with >90% reperfusion show a high correlation between early DWI volume and final infarct volume (r=0.95; P<0.001). Nine patients with <10% reperfusion have a high correlation between baseline PWI (Tmax >6 seconds) volume and final infarct volume (r=0.86; P=0.002). Using all 73 patients, the union of baseline DWI and early follow-up PWI is highly correlated with final infarct volume (r=0.94; P<0.001). The median absolute difference between observed and predicted final volumes is 15 mL (interquartile range, 5.5-30.2).

Conclusions: Baseline DWI and early follow-up PWI (Tmax >6 seconds) volumes provide a reasonable approximation of final infarct volume after endovascular therapy.

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Conflict of interest statement

Disclosures

G. Albers has equity interest in iSchemaView and has worked as a consultant for Covidien and Stryker. R Bammer has equity interest in iSchemaView. G. Zaharchuk receives modest research funding support from GE Healthcare. All other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Correlation of baseline DWI volume to final infarct FLAIR volume in patients with >90% reperfusion
Figure 2
Figure 2
Correlation of early follow-up PWI volume to final infarct FLAIR volume in patients with <10% reperfusion
Figure 3
Figure 3
Correlation of union of baseline DWI with early follow-up PWI volume to final infarct FLAIR volume in patients with partial reperfusion
Figure 4
Figure 4
Bland Altman with 95% Limits of Agreement
See this image and copyright information in PMC

References

    1. Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Annals of Neurology. 2006;60:508–517. - PubMed
    1. Campbell BC, Purushotham A, Christensen S, Desmond PM, Nagakane Y, Parsons MW, et al. The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent. Journal of Cerebral Blood Flow & Metabolim. 2012 Jan;32:50–56. - PMC - PubMed
    1. Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, et al. RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study. Stroke. 2011;42:1608–1614. - PMC - PubMed
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