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Combined SPECT and Diffusion-Weighted MRI as a Predictor of Infarct Growth in Acute Ischemic Stroke

Departments of Clinical Radiology, Neurology, and Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio
Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio
Haaga Neurological Research Center, Helsinki
Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland

Correspondence: For correspondence or reprints contact: Jari O. Karonen, MD, Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.

ABSTRACT

In acute ischemic stroke, the infarcted core is surrounded by a zone of tissue that has decreased perfusion. Some of this tissue may be salvaged by prompt, effective treatment. Diffusion-weighted MRI is sensitive in detecting the infarcted tissue, whereas SPECT also detects the hypoperfused tissue around the infarcted core. We studied the potential of combined diffusion-weighted MRI and SPECT to predict infarct growth and clinical outcome in patients not receiving thrombolytic treatment. Methods: Sixteen patients with acute stroke were examined consecutively with diffusion-weighted MRI and ^99mTc-ethyl cysteinate dimer (^99mTc-ECD) SPECT within 24 h of the onset of symptoms. Follow-up diffusion-weighted MRI was performed on the second day and after 1 wk. The volumes of infarcted and hypoperfused brain tissue were measured from diffusion-weighted MRI and SPECT, respectively. The volume difference between the hypoperfused and infarcted tissue on the first day was compared with the possible increase in infarct volume during the follow-up. Each patient's neurologic status was assessed with the National Institutes of Health Stroke Scale (NIHSS). Results: The volume of infarcted tissue increased from 48 ± 54 cm³ (mean ± SD) on the first day to 88 ± 93 cm³ on the second day (P = 0.001) and to 110 ± 121 cm³ at 1 wk (P = 0.001). The volume of hypoperfused tissue on the first day was significantly greater than the infarct volume (102 ± 135 cm³; P = 0.001). The volume difference between the hypoperfused and infarcted tissue on the first day correlated significantly with the infarct growth between the first day and 1 wk (r = 0.71; P < 0.01). Between the first day and 1 wk, the increase of the infarct volume correlated significantly with the change in the NIHSS (r = 0.54; P < 0.05). Conclusion: A large hypoperfusion zone around the infarct core in the acute phase of ischemic stroke predicts the infarct growth during the first week, and this correlates significantly with the change in the neurologic status of the patient. Combined diffusion-weighted MRI and SPECT performed within 24 h after the onset of symptoms can be useful in the evaluation of acute stroke to predict infarct growth.

Key Words: diffusion • MRI • penumbra • SPECT • stroke

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