Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging
2000; Lippincott Williams & Wilkins; Volume: 31; Issue: 9 Linguagem: Inglês
10.1161/01.str.31.9.2266-e
ISSN1524-4628
AutoresDavid Darby, Mark Parsons, P. Alan Barber, Stephen M. Davis,
Tópico(s)Radiomics and Machine Learning in Medical Imaging
ResumoHomeStrokeVol. 31, No. 9Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBSignificance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging David G. Darby Mark W. Parsons P. Alan Barber Stephen M. Davis David G. DarbyDavid G. Darby Mark W. ParsonsMark W. Parsons P. Alan BarberP. Alan Barber Stephen M. DavisStephen M. Davis For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Departments of Neurology and Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia Originally published1 Sep 2000https://doi.org/10.1161/01.STR.31.9.2266-eStroke. 2000;31:2266–2278To the Editor:We enjoyed reading the study by Roh et al,1 in which MRI diffusion-weighted imaging (DWI) within 4 days of acute stroke showed that multiple noncontiguous lesions were seen in nearly 30% of their cases. In addition, they reported a difference in the presumed embolic pathophysiology on the basis of the involved vascular territories, suggesting that topographical variations are in part related to hypercoagulable states as well as anatomical variations. This observation adds further to the nascent clinical utility of this relatively new technique.23456We would draw the authors' attention to studies performed within hours of the acute stroke,6 showing that similar multiple lesions can be detected, with topography again suggesting embolism. Furthermore, complementary MRI techniques now available include perfusion-weighted imaging (PWI) and angiography (MRA), which can be applied concomitantly with acute DWI. We have recently reported in Stroke4 the predictive utility of consideration of the qualitative topography of these combined techniques in hyperacute stroke. DWI lesions in humans are usually predictive of transition to histological infarction, whereas PWI delineates the presence and severity of ischemia, including regions where infarction is not inevitable.37 Similar multiple lesions, and hence presumed similar pathophysiology, are seen where PWI lesions occur even without DWI lesions. Thus, the combination of techniques is considerably more powerful in identifying both pathophysiology and potential response to intervention.It is our hope as stroke physicians that further characterization of hyperacute PWI/DWI ischemic patterns in appropriately designed prospective studies will be shown to predict which patterns are reversible with selectively targeted therapies. There is every reason to include those patients with noncontiguous multiple DWI and PWI deficits in these trials. References 1 Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH. Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke..2000; 31:688–694.CrossrefMedlineGoogle Scholar2 Warach S, Chien D, Li W, Ronthal M, Edelman RR. Fast magnetic resonance diffusion-weighted imaging of acute human stroke. Neurology..1992; 42:1717–1723.CrossrefMedlineGoogle Scholar3 Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology..1998; 51:418–426.CrossrefMedlineGoogle Scholar4 Darby DG, Barber PA, Gerraty RP, Desmond PM, Yang Q, Parsons M, Li T, Tress BM, Davis SM. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke..1999; 30:2043–2052.CrossrefMedlineGoogle Scholar5 Davis SM, Tress BM, Barber PA, Darby DG, Parsons MW, Gerraty RG, Yang Q, Ting L, Donnan GA. Echoplanar magnetic resonance imaging in acute stroke. J Clin Neurosci..2000; 7:3–9.CrossrefMedlineGoogle Scholar6 Baird AE, Lovblad KO, Schlaug G, Edelman RR, Warach S. Multiple acute stroke syndrome: marker of embolic disease? Neurology..2000; 54:674–678.CrossrefMedlineGoogle Scholar7 Schlaug G, Benfield A, Baird AE, Siewert B, Lovblad KO, Parker RA, Edelman RR, Warach S. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology..1999; 53:1528–1537.CrossrefMedlineGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsResponseRoh Jae-Kyu, MD, PhD and Kang Dong-Wha, MD092000We thank Drs Darby, Parsons, Barber, and Davis for their interest in our workR1 on the significance of acute multiple brain infarction on DWI. DWI has made it easier to discriminate small, multiple, silent ischemic lesions that would have gone unrecognized before the era of DWI. Another study,R2 performed mostly within 24 hours of acute stroke, showed that multiple acute ischemic lesions were present in 17% of patients and that the stroke mechanism was mainly embolic. The different frequency of multiple lesions from ours may be partly due to the different time interval between stroke onset and imaging and the different sample size. The main mechanism of acute multiple ischemic lesions was presumed to be embolic. Additionally, we showed that hypercoagulability and vascular anatomic variations may also play a role in the pathogenesis of bihemispheric ischemic lesions.Acute multiple ischemic lesions may have clinical significance with regard to acute stroke therapies. Darby and colleaguesR3 have reported the predictive utility of pathophysiological topography of acute ischemia through the combination of DWI, PWI, and MRA. PWI lesions without DWI lesions can occur even though they compose a small proportion of acute ischemia. Thus, multiple PWI lesions may have underlying pathophysiology similar to that of the multiple DWI lesions. We agree with the opinion of Darby and colleagues in that the combination of these new techniques is more powerful in determining stroke pathophysiology and therapeutic intervention. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kamran S, Akhtar N, George P, Singh R, Imam Y, Salam A, Babu B, Burke P, Own A, Vattoth S, Perkins J, Parray A, Qadri S and Hamid T (2020) Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2019.104509, 29:2, (104509), Online publication date: 1-Feb-2020. Donnan G, Howells D, Markus R, Toni D and Davis S (2003) Can the Time Window for Administration of Thrombolytics in Stroke be Increased?, CNS Drugs, 10.2165/00023210-200317140-00001, 17:14, (995-1011), . September 2000Vol 31, Issue 9 Advertisement Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.STR.31.9.2266-e Originally publishedSeptember 1, 2000 PDF download Advertisement
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