Within-lesion heterogeneity of subcortical DWI lesion evolution, and stroke outcome: A voxel-based analysis. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Duering, Marco; Adam, Ruth; Wollenweber, Frank A; Bayer-Karpinska, Anna; Baykara, Ebru; Cubillos-Pinilla, Leidy Y; Gesierich, Benno; Araque Caballero, Miguel Á; Stoecklein, Sophia; Ewers, Michael; Pasternak, Ofer; Dichgans, Martin
• Is Part Of: Journal of cerebral blood flow & metabolism. Volume 40:Issue 7(2020)
• Page Start: 1482
• Page End: 1491
• Publication Date: 2020-07
• Subjects: Clinical outcome -- diffusion tensor imaging -- free water -- stroke -- subcortical infarction; Cerebral circulation -- Periodicals; Brain -- Metabolism -- Periodicals; Brain -- Blood-vessels -- Periodicals; Cerebrovascular disease -- Periodicals; 612.824
• DOI: 10.1177/0271678X19865916
• Languages: English
• ISSNs: 0271-678X

Abstract

The fate of subcortical diffusion-weighted imaging (DWI) lesions in stroke patients is highly variable, ranging from complete tissue loss to no visible lesion on follow-up. Little is known about within-lesion heterogeneity and its relevance for stroke outcome. Patients with subcortical stroke and recruited through the prospective DEDEMAS study (NCT01334749) were examined at baseline ( n = 45), six months ( n = 45), and three years ( n = 28) post-stroke. We performed high-resolution structural MRI including DWI. Tissue fate was determined voxel-wise using fully automated tissue segmentation. Within-lesion heterogeneity at baseline was assessed by free water diffusion imaging measures. The majority of DWI lesions (66%) showed cavitation on six months follow-up but the proportion of tissue turning into a cavity was small (9 ± 13.5% of the DWI lesion). On average, 69 ± 25% of the initial lesion resolved without any visually apparent signal abnormality. The extent of cavitation at six months post-stroke was independently associated with clinical outcome, i.e. modified Rankin scale score at six months (OR = 4.71, p = 0.005). DWI lesion size and the free water-corrected tissue mean diffusivity at baseline independently predicted cavitation. In conclusion, the proportion of cavitating tissue is typically small, but relevant for clinical outcome. Within-lesion heterogeneity at baseline on advanced diffusion imaging is predictive of tissue fate.