Characterization and Evolution of Diffusion MR Imaging Abnormalities in Stroke Patients Undergoing Intra-Arterial Thrombolysis

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Fig 1.
Images obtained in three patients in group B who had hyperintense regions at initial DWI that appeared normal at follow-up. Region 1 is DWI-hyperintense tissue that was abnormal at follow-up imaging. Region 2 is DWI-hyperintense tissue that was normal at follow-up imaging.
A, ADC values in square millimeters per second.
B, ADC ratios.
C, DWI ratios.
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Fig 2.
Reversal of DWI-hyperintense lesion after thrombolysis in a 68-year-old man with right-sided weakness and dysarthria. The patient had a left MCA occlusion that was successfully treated with IA tissue plasminogen activator at 6 hours. Initial DWI (row 1) and ADC (row 2) images demonstrate abnormality involving the left basal ganglia, insula, and subinsular region (short arrows) and in the left corona radiata (long arrow). At 3 days, follow-up (F/U) T2-weighted images demonstrate no abnormality in the left corona radiata. Lesions in the basal ganglia, insula, and subinsular region are unchanged. At discharge, the right-sided weakness had resolved.

TABLE 1:

Summary of demographic data and treatment characteristics

Data	All Patients (n = 16)	Group A (n = 13)	Group B (n = 3)
Sex (M:F)	8:8	5:8	3:0
Age, y	68.3 (57–88)	69.0 (57–88)	65.3 (57–71)
Time to treatment, h	5.1 (2.8–6.5)	5.2 (4.2–6.5)	4.5 (2.8–6.3)
Initial NIHSS Score	17.2 (11–21)	17.2 (11–21)	17 (14–21)
Follow-up mRS score	4.6 (2–6)	4.8 (2–6)	3.7 (2–5)
Clot location	8 MCA stem 8 ICA T	5 MCA stem 8 ICA T	3 MCA stem
Recanalization	2 TIMI 3, 9 TIMI 2, 5 TIMI 1	9 TIMI 2, 4 TIMI 1	2 TIMI 3, 1 TIMI 1
Follow-up study, d	3.2 (1–7)	3.1 (1–7)	3.7 (3–5)

Note.—Data are the mean (range) unless otherwise specified. ICA indicates internal carotid artery.

TABLE 2:

Details of demographic data and treatment characteristics

Patient/Age, y/Sex	Clot Location	Initial NIHSS Score	DWI Volume, cm³	Follow-Up Volume, cm³	Time to Treatment, h	Angiographic Result after Thrombolysis	TIMI Grade	mRS Score at Discharge
1/57/M^*	L M1/M2	21	16.81	16.40	3.75	M1, ID and SD open	3	2
2/68/M^*	L M1	16	37.31	24.00	6	M1, ID and SD open	3	4
3/71/M^*	L M1/M2	14	42.40	80.45	4.5	M1 clot persistent with some penetration, moderate collaterals	1	5
4/75/F	R ICA T	17	122.09	276.75	5.33	R ICA T clot persistent with some penetration	1	6
5/57/M	R ICA T	19	118.12	147.5	5	ICA, A1, M1 and SD patent, ID clot persistent	2	5
6/71/F	LM1/M2	11	3.07	4.39	5.25	M1 and SD open, ID open except for angular artery	2	2
7/76/M	R M1	18	35.81	112.79	5.25	M1 and SD open, ID clot persistent	2	4
8/75/F	L ICA T	18	25.51	28.16	5.33	ICA, M1 and ID open, partial filling of SD, A1 clot persistent	2	5
9/88/M	L ICA T	21	120.56	217.26	4.67	ICA, M1 and ID open, partial filling of SD, A1 clot persistent	2	5
10/82/M	R ICA T	20	216.44	420.45	4.75	R ICA T clot persistent with some penetration	1	6
11/78/F	L ICA T	15	80.68	672.45	5	L ICA T clot persistent with some penetration	1	6
12/72/F	L M1	21	30.56	199.31	4.75	M1 partially open with minimal filling of SD	2	6
13/20/F	R ICA T	18	35.86	157.47	6	RICA and M1 open, partial filling of SD, ID occluded	2	5
14/73/F	R M1	21	39.08	132.76	6	M1 open, partial filling of SD and ID	2	5
15/69/F	R ICA T	14	12.9	212.7	4.25	R ICA T clot persistent with some penetration	1	5
16/61/M	L M1	11	14.08	46.37	5.25	M1 and SD open, ID occluded	2	3

Note.—ICA indicates internal carotid artery; ID, inferior division of the MCA; M1, M1 segment of the MCA; NS, not significant; and SD, superior division of the MCA.
* Patients in group B.

TABLE 3:

Volumetric data

Group	Initial Volume, cm³	Follow-up Volume, cm³	Change, %
All (n = 16)	59.45 (3.07–216.4)	171.8 (4.39–672.4)	200.0 (−35.7 to 1548)
Group A (n = 13)	65.75 (3.07–216.4)	202.2 (4.39–672.4)	207.5 (10.3–1548)
Group B (n = 3)	32.17 (16.81–42.40)	40.28 (16.4–80.45)	25.2 (−35.7 to 89.8)