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Original Paper

Free Access

MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter

Berner L.-P.a, d · Cho T.-H.b, d · Haesebaert J.c · Bouvier J.a, d · Wiart M.a, d · Hjort N.f · Klærke Mikkelsen I.f · Derex L.b, d · Thomalla G.g · Pedraza S.h · Østergaard L.f · Baron J.-C.e, i · Nighoghossian N.b, d · Berthezène Y.a, d

Author affiliations

aDepartment of Neuroradiology, bDepartment of Stroke Medicine, and cPôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, dCREATIS, CNRS UMR 5220-INSERM U1044, Université Lyon 1 INSA-Lyon, Lyon, and eINSERM U894, Université Paris Descartes, Sorbonne Paris Cité, France; fCenter of Functionally Integrative Neuroscience, Århus University, Aarhus, Denmark; gKlinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; hDepartment of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain; iDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK

Corresponding Author

Prof. Yves Berthezène, MD, PhD

Service de Neuroradiologie

Hôpital Neurologique Pierre Wertheimer - Hospices Civils de Lyon

59 Boulevard Pinel, FR-69677 Bron Cedex (France)

E-Mail yves.berthezene@chu-lyon.fr

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Cerebrovasc Dis 2016;41:291-297

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Background: In acute ischemic stroke (AIS), gray matter (GM) and white matter (WM) have different vulnerabilities to ischemia. Thus, we compared the evolution of ischemic lesions within WM and GM using MRI. Methods: From a European multicenter prospective database (I-KNOW), available T1-weighted images were identified for 50 patients presenting with an anterior AIS and a perfusion weighted imaging (PWI)/diffusion weighted imaging (DWI) mismatch ratio of 1.2 or more. Six lesion compartments were outlined: initial DWI (b = 1,000 s/mm2) lesion, initial PWI-DWI mismatch (Tmax >4 s and DWI-negative), final infarct mapped on 1-month fluid-attenuated inversion recovery (FLAIR) imaging, lesion growth between acute DWI and 1-month FLAIR, DWI lesion reversal at 1 month and salvaged mismatch. The WM and GM were segmented on T1-weighted images, and all images were co-registered within subjects to the baseline MRI. WM and GM proportions were calculated for each compartment. Results: Fifty patients were eligible for the study. Median delay between symptom onset and baseline MRI was 140 min. The percentage of WM was significantly greater in the following compartments: initial mismatch (52.5 vs. 47.5%, p = 0.003), final infarct (56.7 vs. 43.3%, p < 0.001) and lesion growth (58.9 vs. 41.2%, p < 0.001). No significant difference was found between GM and WM percentages within the initial DWI lesion, DWI reversal and salvaged mismatch compartments. Conclusions: Ischemic lesions may extend preferentially within the WM. Specific therapeutic strategies targeting WM ischemic processes may deserve further investigation.

© 2016 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: November 04, 2015
Accepted: January 10, 2016
Published online: February 12, 2016
Issue release date: April 2016

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

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