Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
QUICK SEARCH:   [advanced]


     

Published online before print March 8, 2006, doi:10.1212/01.wnl.0000202524.43850.81)
This Article
Right arrow Full Text (Rapid PDF)
Right arrow CME: Take the course for this article:
 Volume 66, Number 8, April 25, 2006
Right arrow All Versions of this Article:
01.wnl.0000202524.43850.81v1
66/8/1159    most recent
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hand, P. J.
Right arrow Articles by Dennis, M. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hand, P. J.
Right arrow Articles by Dennis, M. S.
Received June 30, 2005
Accepted December 20, 2005

MR diffusion-weighted imaging and outcome prediction after ischemic stroke

P. J. Hand FRACP, MD, J. M. Wardlaw FRCP, FRCR, MD, FMedSci*, C. S. Rivers MSc, P. A. Armitage PhD, M. E. Bastin PhD, R. I. Lindley FRCP(Edin), FRACP, MD, and M. S. Dennis FRCP, MD

From the Divisions of Clinical Neurosciences (J.M.W., C.S.R., P.A.A.) and Medical Physics (M.E.B., M.S.D.), University of Edinburgh, Western General Hospital, Edinburgh, UK; RMH Stroke Centre (P.J.H.), Department of Neurology, Royal Melbourne Hospital and Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Victoria Australia; and Department of Geriatric Medicine (R.I.L.), Western Clinical School, University of Sydney, Westmead Hospital, New South Wales, Australia.


* To whom correspondence should be addressed. E-mail: joanna.wardlaw{at}ed.ac.uk.

Abstract-- Background: MR diffusion-weighted imaging (DWI) shows acute ischemic lesions early after stroke so it might improve outcome prediction and reduce sample sizes in stroke treatment trials. Previous studies of DWI and outcome produced conflicting results. Objective: To determine whether DWI lesion characteristics independently predict outcome in a broad range of patients with acute stroke. Methods: The authors recruited hospital-admitted patients with all severities of suspected stroke, assessed stroke severity on the NIH Stroke Scale (NIHSS), performed early brain DWI, and assessed outcome at 3 months (modified Rankin Scale). Clinical data and DWI lesion parameters were evaluated in a logistic regression model to identify independent predictors of outcome at 3 months and a previously described "Three-Item Scale" (including DWI) was tested for outcome prediction. Results: Among 82 patients (mean NIHSS 7.1 [±6.3 SD]), the only independent outcome predictors were age and stroke severity. Neither DWI lesion volume nor apparent diffusion coefficient nor the previously described Three-Item Scale predicted outcome independently. Comparison with previous studies suggested that DWI may predict outcome only in patients with more severe cortical ischemic strokes. Conclusions: Across a broad range of stroke severities, diffusion-weighted imaging (DWI) did not predict outcome beyond that of key clinical variables. Thus, DWI is unlikely to reduce sample sizes in acute stroke trials assessing functional outcome, especially where estimated treatment effects are modest.




This article has been cited by other articles:


Home page
 Cereb CortexHome page
V. Di Lazzaro, P. Profice, F. Pilato, F. Capone, F. Ranieri, P. Pasqualetti, C. Colosimo, E. Pravata, A. Cianfoni, and M. Dileone
Motor Cortex Plasticity Predicts Recovery in Acute Stroke
Cereb Cortex, October 5, 2009; (2009) bhp216v1.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
K. M. Barrett, Y. H. Ding, D. P. Wagner, D. F. Kallmes, K. C. Johnston, and for the ASAP Investigators
Change in Diffusion-Weighted Imaging Infarct Volume Predicts Neurologic Outcome at 90 Days: Results of the Acute Stroke Accurate Prediction (ASAP) Trial Serial Imaging Substudy
Stroke, July 1, 2009; 40(7): 2422 - 2427.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
J. R. Sims, L. R. Gharai, P. W. Schaefer, M. Vangel, E. S. Rosenthal, M. H. Lev, and L. H. Schwamm
ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes
Neurology, June 16, 2009; 72(24): 2104 - 2110.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. M. Wardlaw
Surrogate Outcomes: A Cautionary Note
Stroke, April 1, 2009; 40(4): 1029 - 1031.
[Full Text] [PDF]

Home page
 StrokeHome page
V. Cvoro, J. M. Wardlaw, I. Marshall, P. A. Armitage, C. S. Rivers, M. E. Bastin, T. K. Carpenter, K. Wartolowska, A. J. Farrall, and M. S. Dennis
Associations Between Diffusion and Perfusion Parameters, N-Acetyl Aspartate, and Lactate in Acute Ischemic Stroke
Stroke, March 1, 2009; 40(3): 767 - 772.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
K. C. Johnston, D. P. Wagner, X.-Q. Wang, G. C. Newman, V. Thijs, S. Sen, S. Warach, and for the GAIN, Citicoline, and ASAP Investigators
Validation of an Acute Ischemic Stroke Model: Does Diffusion-Weighted Imaging Lesion Volume Offer a Clinically Significant Improvement in Prediction of Outcome? * Definitions and Explanations
Stroke, June 1, 2007; 38(6): 1820 - 1825.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
P. A. Barber and W. Powers
MR DWI does not substitute for stroke severity scores in predicting stroke outcome
Neurology, April 25, 2006; 66(8): 1138 - 1139.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Copyright © 2006 by AAN Enterprises, Inc.