Signal evolution and infarction risk for apparent diffusion coefficient lesions in acute ischemic stroke are both time- and perfusion-dependent.

Journal Article (Journal Article)

BACKGROUND AND PURPOSE: This study aimed to examine the temporal relationship between tissue perfusion and apparent diffusion coefficient (ADC) changes within 6 hours of ischemic stroke onset and how different reperfusion patterns may affect tissue outcome in ADC lesions. METHODS: Thirty-one participants were sequentially imaged at 3 hours, 6 hours, and 1 month post-stroke. Three regions of interest (ROIs) were defined within initial ADC lesions: ROI (1)reperf_3hour hyperacute reperfusion (within 3 hours), ROI (2)reperf_6hour acute reperfusion (3 to 6 hours), and ROI (3)nonreperf no reperfusion (by 6 hours). For each ROI, changes in ADC (ΔADC) from 3 to 6 hours and risks of infarction were examined. RESULTS: The magnitude of initial ADC reduction was similar in all 3 ROIs (P=0.51). ΔADC was strongly associated with reperfusion (P<0.0001) but not with initial ADC reduction (P=0.83). ΔADC in ROI (1)reperf_3hour and ROI (2)reperf_6hour was significantly larger than that of ROI (3)nonreperf (P<0.05). Positive ΔADC was obtained from 3 to 6 hours in ROI (1)reperf_3hour that had restored perfusion before 3 hours, demonstrating a temporal delay between reperfusion and ADC changes. Risks of infarction were significantly higher in ROI (3)nonreperf than those in ROI (1)reperf_3hour and ROI (2)reperf_6hour. CONCLUSIONS: Improvement in ADC did not occur coincidently with reperfusion but showed a temporal delay. Regions with similar initial ADC reductions at 3 hours had different evolution of ADC and infarction risks depending on when or if tissue reperfused. These findings provide a physiological basis for the observation that a single ADC measurement at a fixed time after stroke onset may not accurately predict tissue outcome.

Full Text

Duke Authors

Cited Authors

  • An, H; Ford, AL; Vo, K; Powers, WJ; Lee, J-M; Lin, W

Published Date

  • May 2011

Published In

Volume / Issue

  • 42 / 5

Start / End Page

  • 1276 - 1281

PubMed ID

  • 21454821

Pubmed Central ID

  • PMC3384724

Electronic International Standard Serial Number (EISSN)

  • 1524-4628

Digital Object Identifier (DOI)

  • 10.1161/STROKEAHA.110.610501


  • eng

Conference Location

  • United States