Predicting final infarct size using acute and subacute multiparametric MRI measurements in patients with ischemic stroke

Purpose: To identify early MRI characteristics of ischernic stroke that predict final infarct size three months poststroke. Materials and Methods: Multiparametric MRI (multispin echo T2-weighted [T2W] imaging, T1-weighted [T1W] imaging, and diffusion-weighted imaging [DWI]) was performed acutely (< 24 hours), subacutely (three to five days), and at three months. MRI was processed using maps of apparent diffusion coefficient (ADC), T2, and a self-organizing data analysis (ISODATA) technique. Analyses began with testing for individual MRI parameter effects, followed by multivariable modeling with assessment of predictive ability (le) on final infarct size. Results: A total of 45 patients were studied, 15 of whom were treated with tissue plasminogen activator (tPA) before acute MRI. The acute DWI and DWI-ISODATA mismatch lesion size, and the interactions of ADC, T2, and T2W imaging lesion with tPA remained in the final multivariable model (R-2 = 70%). A large acute DWI lesion or DWI < ISODATA lesion independently predicted increase in the final infract size, with predictive ability 68%. Predictive ability increased (R-2 = 83%) when subacute MRI parameters were included along with acute DWI, DWI-ISODATA mismatch, and acute T2W image lesion size by tPA treatment interaction. Subacute DWI > acute DWI lesion size predicted an increased final infarct size (P < 0.01). Conclusion: Acute-phase DWI and DWI-ISODATA mismatch strongly predict the final infaret size. An acute-to-subacute DWI lesion size change further increases the predictive ability of the model.