J Korean Soc Radiol.  2016 Apr;74(4):245-253. 10.3348/jksr.2016.74.4.245.

Change of Apparent Diffusion Coefficient Immediately after Recanalization through Intra-Arterial Revascularization Therapy in Acute Ischemic Stroke

Affiliations
  • 1Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea. skbaik9@gmail.com
  • 2Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 3Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

PURPOSE
Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke.
MATERIALS AND METHODS
ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI).
RESULTS
Mean ADC values of the overall 25 lesions before IART were 415.12 × 10(-6) mm2/sec, and increased to 619.08 × 10(-6) mm2/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly.
CONCLUSION
There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.


MeSH Terms

Cerebral Infarction
Diffusion*
Hand
Humans
Infarction
Magnetic Resonance Imaging
Mechanical Thrombolysis
Reperfusion
Stroke*

Figure

  • Fig. 1 Change in ADC value after full-recanalization of a TI lesion (case no. 4). Acute infarction in right MCA territory is seen on the pre-recanalization DWI (A, B). Occluded right proximal MCA can be seen in pre-recanalization angiography (C, left), and the right MCA is recanalized after mechanical thrombectomy (C, right). After successful recanalization, increased ADC is noted on the post-recanalization image (D). ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, MCA = middle cerebral artery, TI = territorial infarction

  • Fig. 2 A 77-year-old male patient with left MCA territory infarction (case no. 10). Initial DWI and ADC maps show acute infarction at the level of superior division territory of left MCA (A, B) and inferior division territory (C, D). Severe stenosis of left distal M1 is seen on pre-recanalization angiography (E). Angiography after IA injection of tirofiban (F) presents recanalization of inferior division and still occluded superior division. Post-recanalization ADC map (G) shows no remarkable change in superior division territory, but increased ADC in recanalized inferior division territory (H). ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, MCA = middle cerebral artery

  • Fig. 3 Change in ADC value after full-recanalization of a WI lesion (case no. 9). Acute infarction is seen in right internal border zone (A, B). The right proximal MCA is occluded (C, left) and after successful mechanical thrombectomy (C, right), post-recanalization ADC map (D) shows no significant change in comparison with pre-recanalization image. ADC = apparent diffusion coefficient, MCA = middle cerebral artery, WI = watershed infarction


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