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Vincent N. Thijs, MD; Alessandro Adami, MD; Tobias Neumann-Haefelin, MD; Michael E. Moseley, PhD; Gregory W. Albers, MD

Arch Neurol. 2002;59:233-238.

Background  Methods for determining cerebral blood flow (CBF) using bolus-tracking magnetic resonance imaging (MRI) have recently become available. Reduced apparent diffusion coefficient (ADC) values of brain tissue are associated with reductions in regional CBF in animal stroke models.

Objectives  To determine the clinical and radiological features of patients with severe reductions in CBF on MRI and to analyze the relationship between reduced CBF and ADCs in acute ischemic stroke.

Design  Case series.

Setting  Referral center.

Methods  We studied 17 patients with nonlacunar acute ischemic stroke in whom perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) were performed within 7 hours of symptom onset. A PWI-DWI mismatch of more than 20% was required. We compared patients with ischemic lesions that had CBF of less than 50% relative to the contralateral hemisphere with patients with lesions that had relative CBF greater than 50%. Characteristics analyzed included age, time to MRI, baseline National Institutes of Health Stroke Scale score, mean ADC, DWI and PWI lesion volumes, and 1-month Barthel Index score.

Results  Patients with low CBF (n = 5) had lower ADC values (median, 430 x 10 ^-6 mm²/s vs 506 x 10 ^-6 mm²/s; P = .04), larger DWI volumes (median, 41.8 cm³ vs 14.5 cm³; P = .001) and larger PWI lesions as defined by the mean transit time volume (median, 194.6 cm³ vs 69.3 cm³; P = .01), and more severe baseline National Institutes of Health Stroke Scale scores (median, 15 vs 9; P = .02).

Conclusion  Ischemic lesions with severe CBF reductions, measured using bolus-tracking MRI, are associated with lower mean ADCs, larger DWI and PWI volumes, and higher National Institutes of Health Stroke Scale scores.

From the Department of Neurology and Neurological Sciences, Stanford Stroke Center (Drs Thijs, Adami, and Albers), and the Section of Neuroradiology, Department of Radiology (Dr Moseley), Stanford University Medical Center, Palo Alto, Calif; the Department of Neurology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium (Dr Thijs); Clinica Neurologica, Universitá di Verona, Verona, Italy (Dr Adami); and the Department of Neurology, Johann Wolfgang-Goethe Universität, Frankfurt, Germany (Dr Neumann-Haefelin).

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