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Research ArticleBRAIN

Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging

Pamela W. Schaefer, George J. Hunter, Julian He, Leena M. Hamberg, A. Gregory Sorensen, Lee H. Schwamm, Walter J. Koroshetz and R. Gilberto Gonzalez
American Journal of Neuroradiology November 2002, 23 (10) 1785-1794;
Pamela W. Schaefer
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George J. Hunter
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Julian He
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Leena M. Hamberg
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A. Gregory Sorensen
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Lee H. Schwamm
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Walter J. Koroshetz
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R. Gilberto Gonzalez
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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.

  • Fig 3.
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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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    TABLE:

    Sensitivity and specificity of DW imaging and perfusion parameters in 134 patients

    TechniqueFinal DiagnosisSensitivity (%)Specificity (%)PPV (%)NPV (%)FPFN
    PositiveNegative
    DWI
     Positive10119496998116
     Negative626
    CBV
     Positive7807410010050028
     Negative2828
    CBF
     Positive89184969959118
     Negative1826
    MTT
     Positive89184969959118
     Negative1826
    • Note.—FN indicates false-negative findings; FP, false-positive findings; NPV, negative predictive value; PPV, positive predictive value.

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American Journal of Neuroradiology: 23 (10)
American Journal of Neuroradiology
Vol. 23, Issue 10
1 Nov 2002
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Cite this article
Pamela W. Schaefer, George J. Hunter, Julian He, Leena M. Hamberg, A. Gregory Sorensen, Lee H. Schwamm, Walter J. Koroshetz, R. Gilberto Gonzalez
Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging
American Journal of Neuroradiology Nov 2002, 23 (10) 1785-1794;

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Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging
Pamela W. Schaefer, George J. Hunter, Julian He, Leena M. Hamberg, A. Gregory Sorensen, Lee H. Schwamm, Walter J. Koroshetz, R. Gilberto Gonzalez
American Journal of Neuroradiology Nov 2002, 23 (10) 1785-1794;
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