Skip to main content

Advertisement

SpringerLink
Log in

Diffusion weighted imaging, apparent diffusion coefficient maps and stroke etiology

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Objective

In acute ischemic stroke, the number and distribution of lesions on diffusion weighted imaging (DWI) have been shown to give clues to the underlying pathogenetic mechanisms. The objective of this study was to determine whether lesion features on DWI differ between stroke due to large artery atherosclerosis (LAA) and cardioembolism (CE), and to assess the role of apparent diffusion coefficient maps (ADC).

Methods

We retrospectively studied 83 consecutive patients with stroke caused by either LAA (n = 40) or cardioembolism (n = 43). DWI lesions were characterized by number, size, distribution (i. e. lesion pattern) and signal intensity on ADC maps. In part A, all hyperintense DWI lesions regardless of their ADC were compared. In part B, only hyperintense DWI lesions with hypointense appearance on ADC maps (i. e. acute lesions) were assessed.

Results

Part A: The frequency of multiple hyperintense DWI lesions (LAA: 28/40, CE: 21/43; p < 0.05) and the lesion number (LAA 4.7 ± 4.9; CE: 3.1 ± 4.7; p = 0.01) were higher in LAA–patients. Involvement of >1 circulation (i. e. anterior plus posterior or bilateral anterior circulations) was present in 5 LAA–patients (13 %) and 4 CE–patients (9 %). Lesion size did not differ between LAA–stroke (35.1 ± 33.7 mm) and CE–stroke (35.4 ± 27.8 mm). Part B: Multiple hyperintense DWI lesions with low ADC occurred in 23/40 LAA–patients and in 15/43 CE–patients (p < 0.05). Lesions in >1 circulation occurred only in CE–stroke (n = 3; 7%) and never in LAA–stroke.

Conclusions

(1) Multiple ischemic lesions occur significantly more often in LAA–stroke than in CE–stroke. (2) ADC maps are important in the comparison of DWI lesion patterns; DWI lesions in > 1 circulation can only be assigned to a cardioembolic etiology if they appear hypointense on ADC maps.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41

    PubMed  Google Scholar 

  2. Altieri M, Metz RJ, Muller C, Maeder P, Meuli R, Bogousslavsky J (1999) Multiple brain infarcts: clinical and neuroimaging patterns using diffusionweighted magnetic resonance. Eur Neurol 42:76–82

    Article  PubMed  CAS  Google Scholar 

  3. Baird AE, Lovblad KO, Schlaug G, Edelman RR, Warach S (2000) Multiple acute stroke syndrome: marker of embolic disease? Neurology 54:674–678

    PubMed  CAS  Google Scholar 

  4. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526

    Article  PubMed  CAS  Google Scholar 

  5. de Bray JM, Pasco A, Tranquart F, Papon X, Alecu C, Giraudeau B, Dubas F, Emile J (2001) Accuracy of color– Doppler in the quantification of proximal vertebral artery stenoses. Cerebrovasc Dis 11:335–340

    Article  PubMed  CAS  Google Scholar 

  6. DeWitt LD, Rosengart A, Teal PA (1993) Transcranial Doppler Ultrasonography: Normal Values. In: Babikian VL,Wechsler LR (eds) Transcranial Doppler Ultrasonography. Mosby, St. Louis, Missouri, pp 29–38

  7. Engelter ST, Wetzel SG, Radue EW, Rausch M, Steck AJ, Lyrer PA (2004) The clinical significance of diffusionweighted MR imaging in infratentorial strokes. Neurology 62:574–580

    PubMed  CAS  Google Scholar 

  8. Kang DW, Chalela JA, Ezzeddine MA, Warach S (2003) Association of ischemic lesion patterns on early diffusion–weighted imaging with TOAST stroke subtypes. Arch Neurol 60:1730–1734

    PubMed  Google Scholar 

  9. Kang DW, Chu K, Ko SB, Kwon SJ, Yoon BW, Roh JK (2002) Lesion patterns and mechanism of ischemia in internal carotid artery disease: a diffusionweighted imaging study. Arch Neurol 59:1577–1582

    Article  PubMed  Google Scholar 

  10. Keir SL, Wardlaw JM, Bastin ME, Dennis MS (2004) In which patients is diffusion– weighted magnetic resonance imaging most useful in routine stroke care? J Neuroimaging 14:118–122

    Article  PubMed  CAS  Google Scholar 

  11. Koennecke HC, Bernarding J, Braun J, Faulstich A, Hofmeister C, Nohr R, Leistner S, Marx P (2001) Scattered brain infarct pattern on diffusionweighted magnetic resonance imaging in patients with acute ischemic stroke. Cerebrovasc Dis 11:157–163

    Article  PubMed  CAS  Google Scholar 

  12. Lansberg MG, Norbash AM, Marks MP, Tong DC, Moseley ME, Albers GW (2000) Advantages of adding diffusionweighted magnetic resonance imaging to conventional magnetic resonance imaging for evaluating acute stroke. Arch Neurol 57:1311–1316

    Article  PubMed  CAS  Google Scholar 

  13. Lee PH, Bang OY, Oh SH, Joo IS, Huh K (2003) Subcortical white matter infarcts: comparison of superficial perforating artery and internal borderzone infarcts using diffusion–weighted magnetic resonance imaging. Stroke 34:2630–2635

    PubMed  Google Scholar 

  14. Moseley ME, Cohen Y, Mintorovitch J, Chileuitt L, Shimizu H, Kucharczyk J, Wendland MF, Weinstein PR (1990) Early detection of regional cerebral ischemia in cats: comparison of diffusion– and T2–weighted MRI and spectroscopy. Magn Reson Med 14:330–346

    PubMed  CAS  Google Scholar 

  15. Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH (2000) Significance of acute multiple brain infarction on diffusionweighted imaging. Stroke 31:688–694

    PubMed  CAS  Google Scholar 

  16. Schaefer PW, Hunter GJ, He J, Hamberg LM, Sorensen AG, Schwamm LH, Koroshetz WJ, Gonzalez RG (2002) Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol 23:1785–1794

    PubMed  Google Scholar 

  17. Schlaug G, Siewert B, Benfield A, Edelman RR, Warach S (1997) Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology 49:113–119

    PubMed  CAS  Google Scholar 

  18. Schwamm LH, Koroshetz WJ, Sorensen AG, Wang B, Copen WA, Budzik R, Rordorf G, Buonanno FS, Schaefer PW, Gonzalez RG (1998) Time course of lesion development in patients with acute stroke: serial diffusion– and hemodynamic–weighted magnetic resonance imaging. Stroke 29:2268–2276

    PubMed  CAS  Google Scholar 

  19. Singhal AB, Topcuoglu MA, Buonanno FS (2002) Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a diffusionweighted magnetic resonance imaging study. Stroke 33:1267–1273

    Article  PubMed  Google Scholar 

  20. Szabo K, Kern R, Gass A, Hirsch J, Hennerici M (2001) Acute stroke patterns in patients with internal carotid artery disease: a diffusion–weighted magnetic resonance imaging study. Stroke 32:1323–1329

    PubMed  CAS  Google Scholar 

  21. Takahashi K, Kobayashi S, Matui R, Yamaguchi S, Yamashita K (2002) The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by diffusion–weighted MRI. Acta Neurol Scand 106:24–29

    Article  PubMed  CAS  Google Scholar 

  22. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (2001) Arterial territories of the human brain. In: Bogousslavsky J, Caplan LR (eds) Stroke Syndromes. Cambridge University Press, Cambridge, United Kingdom, pp 375–404

  23. Warach S, Benfield A, Edelman RR (1995) Time course of abnormal apparent diffusion coefficient in human stroke. Proc Soc Magn Reson 1:82

    Google Scholar 

  24. Warach S, Chien D, Li W, Ronthal M, Edelman RR (1992) Fast magnetic resonance diffusion–weighted imaging of acute human stroke. Neurology 42:1717–1723

    PubMed  CAS  Google Scholar 

  25. Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR (1995) Acute human stroke studied by whole brain echo planar diffusion–weighted magnetic resonance imaging. Ann Neurol 37:231–241

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology and Stroke Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    L. H. Bonati MD, P. A. Lyrer MD, A. J. Steck MD & S. T. Engelter MD

  2. Dept. of Radiology, University Hospital Basel, Basel, Switzerland

    S. G. Wetzel MD

Authors
  1. L. H. Bonati MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. A. Lyrer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. G. Wetzel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. J. Steck MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. T. Engelter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. H. Bonati MD.

Additional information

Funding: This study was supported, in part, by the Basel Stroke Fund. S.Wetzel was supported, in part, by a grant from the Swiss National Science Foundation (grant 3200–066634).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonati, L.H., Lyrer, P.A., Wetzel, S.G. et al. Diffusion weighted imaging, apparent diffusion coefficient maps and stroke etiology. J Neurol 252, 1387–1393 (2005). https://doi.org/10.1007/s00415-005-0881-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-005-0881-1

Key words

Search

Navigation