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AJNR - American Journal of Neuroradiology

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Vascular Occlusion Sites Determine Differences in Lesion Growth from Early Apparent Diffusion Coefficient Lesion to Final Infarct

Jens Fiehler^a, Karina Knudsen^a, Götz Thomalla^b, Einar Goebell^a, Michael Rosenkranz^b, Cornelius Weiller^b, Joachim Röther^b, Hermann Zeumer^a and Thomas Kucinski^a

^a Department of Neuroradiology, University Hospital Eppendorf, University of Hamburg, Germany
^b Department of Neurology, University Hospital Eppendorf, University of Hamburg, Germany

View larger version (104K): [in a new window]   FIG 1. Types of occlusion were defined on MRA, as follows: a + c was an occlusion of the ICA at the neck accompanied by an MCA embolism, or ICA/MCA occlusion; b, occlusion of the intracranial bifurcation of the ICA, or carotid T occlusion, which included one of 17 cases with an occlusion of the proximal anterior and middle cerebral artery; c, occlusion of the MCA trunk, which included nine of 48 occlusions of the bifurcation or trifurcation lateral to the medial lenticulostriate arteries; and d, occlusion of a single or multiple MCA branch occlusion with free trifurcation, which included three of 36 cases with an additional occlusion of the peripheral anterior cerebral artery.

View larger version (36K): [in a new window]   FIG 2. Boxplots of lesion volumes for ADCman <6 hours after stroke onset and lesion volume on days 5–8 (on T2-weighted or CT images) for each type of occlusion. Asterisk = significant differences in ADCman in multiple pairwise comparisons between types. Infarct volumes were significantly different (P < .05) for all types except for ICA/MCA versus MCA trunk occlusions (MCA-trunc). CTO = carotid-T occlusion.

View larger version (29K): [in a new window]   FIG 3. Reperfusion assessed on day 1 after stroke onset for each type of occlusion in 65 patients treated with intravenous thrombolysis. CTO = carotid-T occlusion.

View larger version (118K): [in a new window]   FIG 4. T2-weighted (b = 0 s/mm2, top) and ADC (bottom) images obtained in patients with proximal vascular occlusions show considerable lesion growth without recanalization. Left box, Images obtained in a 71-year-old man with an ICA/MCA occlusion treated with intravenous thrombolysis. Right box, Images in a 67-year-old woman with a carotid-T occlusion treated with craniotomy.

View larger version (113K): [in a new window]   FIG 5. Smallest (top row) and largest (bottom row) ADC lesions <6 hours after stroke onset are depicted for each type of occlusion (arrow). Section showing the maximal extent of the lesion was chosen in each case. CTO = carotid-T occlusion.