J Clin Neurol.  2010 Mar;6(1):19-26. 10.3988/jcn.2010.6.1.19.

Can Early Ischemic Lesion Recurrence on Diffusion-Weighted MRI Affect Functional Outcome after Acute Ischemic Stroke?

• Kim WJ
• Kim JH
• Ko Y
• Park JH
• Yang MH
• Jang MS
• Han MK
• Kim SY
• Park SH
• Bae HJ

• KMID: 2135477
• DOI: http://doi.org/10.3988/jcn.2010.6.1.19

Abstract

BACKGROUND AND PURPOSE
Ischemic lesion recurrence on diffusion-weighted imaging (DWI-LR) is a frequently observed phenomenon after acute ischemic stroke. However, no study has elucidated the impact of DWI-LR on functional outcome.
METHODS
Among a consecutive series of patients who presented with focal symptoms or signs compatible with stroke within 48 hours from the onset over a 50-month period, those who had relevant ischemic lesions on initial DWI and underwent follow-up DWI within 14 days after the onset were enrolled in this study. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 3 months and 1 year were measured prospectively and dichotomized into good (0-2) vs. poor (3-6). When calculating odds ratios (ORs), adjustment was performed for age, previous stroke, initial score on the NIH Stroke Scale, stroke subtype, and IV thrombolysis.
RESULTS
Among those 786 patients finally enrolled in this study, 221 (28.1%) had DWI-LR. For a poor outcome at 3 months, the crude ORs of any, symptomatic, and asymptomatic DWI-LR were 2.70 [95% confidence interval (CI), 1.96 to 3.72], 10.03 (95% CI, 4.39 to 22.96), and 2.04 (95% CI, 1.44 to 2.88), respectively. With adjustment, the OR of symptomatic DWI-LR was 6.44 (95% CI, 2.50 to 16.57), whereas those of any and asymptomatic DWI-LR lost their statistical significance: 1.44 (95% CI, 0.94 to 2.20) and 1.04 (95% CI, 0.65 to 1.65), respectively. Analyzing with the 1-year outcome produced similar results.
CONCLUSIONS
This study shows that symptomatic early lesion recurrence can affect functional outcome after acute ischemic stroke, whereas an asymptomatic one may not.

Keyword

diffusion MRI; cerebral infarction; recurrence; modified Rankin Disability Scale

MeSH Terms

Cerebral Infarction
Diffusion Magnetic Resonance Imaging
Electrolytes
Follow-Up Studies
Humans
Odds Ratio
Prospective Studies
Recurrence
Stroke
Electrolytes

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