Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging
Pamela W. Schaefera,
George J. Huntera,
Julian Hea,
Leena M. Hamberga,
A. Gregory Sorensena,
Lee H. Schwammb,
Walter J. Koroshetzb and
R. Gilberto Gonzaleza
a Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
b Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
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FIG 1. A–D, Scatterplots demonstrate initial lesion volume with each technique versus final lesion volume at follow-up (F-U) in 81 patients.
A, Initial DW imaging versus follow-up: r2 = 0.9, slope = 1 .24 ± 0.08 (95% confidence limits).
B, Initial CBV versus follow-up: r2 = 0.84, slope = 1 .22 ± 0.11.
C, Initial CBF versus follow-up: r2 = 0.35, slope = 0.44 ± 0.09.
D, Initial MTT versus follow-up: r2 = 0.22, slope = 0.32 ± 0.08.
r2 indicates coefficient of determination.
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FIG 2. A–F, Scatterplots show initial lesion volume versus final infarct volume in patients with a perfusion-diffusion mismatch (perfusion lesion more than 20% larger than the diffusion lesion).
A and B, DW-CBV mismatch group: For DW imaging versus follow-up, the regression line was significantly different from the line of identity (P < .001). For CBV versus follow-up, the regression line was not significantly different from the line of identity (P = .18).
C and D, DW-CBF mismatch group: For DW imaging versus follow-up and for CBF versus follow-up, the line of regression was significantly different from the line of identity (P < .001).
E and F, DW-MTT mismatch group: For DW imaging versus follow-up and for MTT versus follow-up, the line of regression was significantly different from the line of identity (P < .001). r2 indicates coefficient of determination.
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FIG 3. A, Axial DW image demonstrates an infarct involving the left basal ganglia, insula, and subinsular region.
B, CBV map shows the lesion is larger than the initial DW imaging abnormality; it also involves the left frontal and parietal opercula.
C and D, CBF (C) and MTT (D) abnormalities involve most of the left middle cerebral artery distribution.
E, Follow-up (F/u) T2-weighted image 10 days later demonstrates a lesion similar in size to that of the initial CBV abnormality (B).
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FIG 4. Percentage of patients with diffusion-perfusion mismatches for proximal (black bars) and nonproximal (white bars) infarctions.
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