Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke

I. Linfante, R. H. Llinas, G. Schlaug, C. Chaves, S. Warach, L. R. Caplan

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Abstract

Background: Occlusive disease of the posterior circulation represents a heterogeneous group of strokes that differ in etiology, clinical presentation, and prognosis. Computed tomography provides suboptimal visualization of posterior-circulation infarcts. Anatomic definition of traditional magnetic resonance imaging sequences has been used for clinicoradiologic correlation in patients with posterior-circulation disease. These studies focused on the subacute rather than the acute phase of ischemia. Lesion volumes on diffusion-weighted imaging (DWI) and perfusion imaging were found to have a good correlation with 24-hour National Institutes of Health stroke scale (NIHSS) score in ischemia of the anterior circulation. Correlation between NIHSS score and lesion volume in posterior-circulation infarcts is unknown. Objectives: To investigate whether DWI is useful for clinicoradiologic correlation of posterior-circulation ischemia within 24 hours after symptom onset and whether NIHSS score correlates with lesion volumes in patients with posterior-circulation stroke. Patients and Methods: In a database analysis of 631 patients with stroke from June 26, 1996, to July 30, 1999, 115 patients (18%) had symptoms of posterior-circulation ischemia by imaging and clinical criteria. Among these 115, we included all patients (n=40) who underwent DWI within 24 hours from symptom onset (mean, 9.7±7.1 hours). All 40 patients also underwent magnetic resonance angiography and T2-weighted imaging. Seventy-five did not meet inclusion criteria: in 45, magnetic resonance imaging was performed more than 24 hours after symptom onset; 12 did not have DWI; in 11 patients, symptoms resolved within 24 hours; 6 had hemorrhages; and 1 had a border zone infarct. Results: An acute lesion on DWI corresponding to the patient's symptoms was detected in all 40 patients, 16 (40%) of whom had detectable acute lesions on T2-weighted images. The lesions on DWI were larger in 11 of the 16 patients with positive T2-weighted images. Acute lesion volume did not correlate with NIHSS score (n=40; ρ=0.30; P=.06, Spearman rank) also when DWI lesion volumes were divided by cause and territory. Conclusions: Diffusion-weighted imaging is more effective than T2-weighted imaging in patients with acute posterior-circulation strokes. The DWI lesion volume did not significantly correlate with NIHSS score, suggesting that NIHSS is more weighted toward anterior-circulation stroke symptoms.

Original languageEnglish (US)
Pages (from-to)621-628
Number of pages8
JournalArchives of Neurology
Volume58
Issue number4
StatePublished - 2001

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National Institutes of Health (U.S.)
Stroke
Ischemia
Health
Imaging
Magnetic Resonance Imaging
Lesion
Perfusion Imaging
Magnetic Resonance Angiography
Tomography
Databases
Hemorrhage

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Linfante, I., Llinas, R. H., Schlaug, G., Chaves, C., Warach, S., & Caplan, L. R. (2001). Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke. Archives of Neurology, 58(4), 621-628.

Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke. / Linfante, I.; Llinas, R. H.; Schlaug, G.; Chaves, C.; Warach, S.; Caplan, L. R.

In: Archives of Neurology, Vol. 58, No. 4, 2001, p. 621-628.

Research output: Contribution to journalArticle

Linfante, I, Llinas, RH, Schlaug, G, Chaves, C, Warach, S & Caplan, LR 2001, 'Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke', Archives of Neurology, vol. 58, no. 4, pp. 621-628.
Linfante, I. ; Llinas, R. H. ; Schlaug, G. ; Chaves, C. ; Warach, S. ; Caplan, L. R. / Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke. In: Archives of Neurology. 2001 ; Vol. 58, No. 4. pp. 621-628.
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title = "Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke",
abstract = "Background: Occlusive disease of the posterior circulation represents a heterogeneous group of strokes that differ in etiology, clinical presentation, and prognosis. Computed tomography provides suboptimal visualization of posterior-circulation infarcts. Anatomic definition of traditional magnetic resonance imaging sequences has been used for clinicoradiologic correlation in patients with posterior-circulation disease. These studies focused on the subacute rather than the acute phase of ischemia. Lesion volumes on diffusion-weighted imaging (DWI) and perfusion imaging were found to have a good correlation with 24-hour National Institutes of Health stroke scale (NIHSS) score in ischemia of the anterior circulation. Correlation between NIHSS score and lesion volume in posterior-circulation infarcts is unknown. Objectives: To investigate whether DWI is useful for clinicoradiologic correlation of posterior-circulation ischemia within 24 hours after symptom onset and whether NIHSS score correlates with lesion volumes in patients with posterior-circulation stroke. Patients and Methods: In a database analysis of 631 patients with stroke from June 26, 1996, to July 30, 1999, 115 patients (18{\%}) had symptoms of posterior-circulation ischemia by imaging and clinical criteria. Among these 115, we included all patients (n=40) who underwent DWI within 24 hours from symptom onset (mean, 9.7±7.1 hours). All 40 patients also underwent magnetic resonance angiography and T2-weighted imaging. Seventy-five did not meet inclusion criteria: in 45, magnetic resonance imaging was performed more than 24 hours after symptom onset; 12 did not have DWI; in 11 patients, symptoms resolved within 24 hours; 6 had hemorrhages; and 1 had a border zone infarct. Results: An acute lesion on DWI corresponding to the patient's symptoms was detected in all 40 patients, 16 (40{\%}) of whom had detectable acute lesions on T2-weighted images. The lesions on DWI were larger in 11 of the 16 patients with positive T2-weighted images. Acute lesion volume did not correlate with NIHSS score (n=40; ρ=0.30; P=.06, Spearman rank) also when DWI lesion volumes were divided by cause and territory. Conclusions: Diffusion-weighted imaging is more effective than T2-weighted imaging in patients with acute posterior-circulation strokes. The DWI lesion volume did not significantly correlate with NIHSS score, suggesting that NIHSS is more weighted toward anterior-circulation stroke symptoms.",
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T1 - Diffusion-weighted imaging and National Institutes of Health stroke scale in the acute phase of posterior-circulation stroke

AU - Linfante, I.

AU - Llinas, R. H.

AU - Schlaug, G.

AU - Chaves, C.

AU - Warach, S.

AU - Caplan, L. R.

PY - 2001

Y1 - 2001

N2 - Background: Occlusive disease of the posterior circulation represents a heterogeneous group of strokes that differ in etiology, clinical presentation, and prognosis. Computed tomography provides suboptimal visualization of posterior-circulation infarcts. Anatomic definition of traditional magnetic resonance imaging sequences has been used for clinicoradiologic correlation in patients with posterior-circulation disease. These studies focused on the subacute rather than the acute phase of ischemia. Lesion volumes on diffusion-weighted imaging (DWI) and perfusion imaging were found to have a good correlation with 24-hour National Institutes of Health stroke scale (NIHSS) score in ischemia of the anterior circulation. Correlation between NIHSS score and lesion volume in posterior-circulation infarcts is unknown. Objectives: To investigate whether DWI is useful for clinicoradiologic correlation of posterior-circulation ischemia within 24 hours after symptom onset and whether NIHSS score correlates with lesion volumes in patients with posterior-circulation stroke. Patients and Methods: In a database analysis of 631 patients with stroke from June 26, 1996, to July 30, 1999, 115 patients (18%) had symptoms of posterior-circulation ischemia by imaging and clinical criteria. Among these 115, we included all patients (n=40) who underwent DWI within 24 hours from symptom onset (mean, 9.7±7.1 hours). All 40 patients also underwent magnetic resonance angiography and T2-weighted imaging. Seventy-five did not meet inclusion criteria: in 45, magnetic resonance imaging was performed more than 24 hours after symptom onset; 12 did not have DWI; in 11 patients, symptoms resolved within 24 hours; 6 had hemorrhages; and 1 had a border zone infarct. Results: An acute lesion on DWI corresponding to the patient's symptoms was detected in all 40 patients, 16 (40%) of whom had detectable acute lesions on T2-weighted images. The lesions on DWI were larger in 11 of the 16 patients with positive T2-weighted images. Acute lesion volume did not correlate with NIHSS score (n=40; ρ=0.30; P=.06, Spearman rank) also when DWI lesion volumes were divided by cause and territory. Conclusions: Diffusion-weighted imaging is more effective than T2-weighted imaging in patients with acute posterior-circulation strokes. The DWI lesion volume did not significantly correlate with NIHSS score, suggesting that NIHSS is more weighted toward anterior-circulation stroke symptoms.

AB - Background: Occlusive disease of the posterior circulation represents a heterogeneous group of strokes that differ in etiology, clinical presentation, and prognosis. Computed tomography provides suboptimal visualization of posterior-circulation infarcts. Anatomic definition of traditional magnetic resonance imaging sequences has been used for clinicoradiologic correlation in patients with posterior-circulation disease. These studies focused on the subacute rather than the acute phase of ischemia. Lesion volumes on diffusion-weighted imaging (DWI) and perfusion imaging were found to have a good correlation with 24-hour National Institutes of Health stroke scale (NIHSS) score in ischemia of the anterior circulation. Correlation between NIHSS score and lesion volume in posterior-circulation infarcts is unknown. Objectives: To investigate whether DWI is useful for clinicoradiologic correlation of posterior-circulation ischemia within 24 hours after symptom onset and whether NIHSS score correlates with lesion volumes in patients with posterior-circulation stroke. Patients and Methods: In a database analysis of 631 patients with stroke from June 26, 1996, to July 30, 1999, 115 patients (18%) had symptoms of posterior-circulation ischemia by imaging and clinical criteria. Among these 115, we included all patients (n=40) who underwent DWI within 24 hours from symptom onset (mean, 9.7±7.1 hours). All 40 patients also underwent magnetic resonance angiography and T2-weighted imaging. Seventy-five did not meet inclusion criteria: in 45, magnetic resonance imaging was performed more than 24 hours after symptom onset; 12 did not have DWI; in 11 patients, symptoms resolved within 24 hours; 6 had hemorrhages; and 1 had a border zone infarct. Results: An acute lesion on DWI corresponding to the patient's symptoms was detected in all 40 patients, 16 (40%) of whom had detectable acute lesions on T2-weighted images. The lesions on DWI were larger in 11 of the 16 patients with positive T2-weighted images. Acute lesion volume did not correlate with NIHSS score (n=40; ρ=0.30; P=.06, Spearman rank) also when DWI lesion volumes were divided by cause and territory. Conclusions: Diffusion-weighted imaging is more effective than T2-weighted imaging in patients with acute posterior-circulation strokes. The DWI lesion volume did not significantly correlate with NIHSS score, suggesting that NIHSS is more weighted toward anterior-circulation stroke symptoms.

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