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Background and Purpose— We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI). Methods— Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient +4 seconds (TTP >+4s ) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADC core ) and relative ADC within the ADC +4s (208 versus 125 mL; P 82 mL, 87%, 91%; TTP >+4s >162 mL, 83%, 75%; TTP/ADC mismatch ratio <2.4, 80%, 79%; ADC core <300 mm 2 /s, 83%, 85%; rADC lesion <0.62, 79%, 74%; and NIHSS score at admission ≥19, 96%, 72%. Conclusions— Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.
Thomalla et al. (Tue,) studied this question.