Sebastian Koch1, Mark S McClendon, Rita Bhatia. 1. Department of Neurology, Miller School of Medicine, University of Miami, 1150 NW 14th Street, Suite 304, Miami, FL 33141, USA. skoch@med.miami.edu
Abstract
BACKGROUND: In acute lacunar infarction, MRI may overestimate eventual infarct size and the imaging evolution of acute lesions is not fully understood. Our objective was to examine eventual infarct size, the incidence of cavity formation, and factors associated with cavitation in patients presenting with acute lacunar infarction. METHODS: Patients with acute diffusion-weighted imaging (DWI) infarcts ≤25 mm in diameter, in the distribution of a penetrating artery, who had a follow-up MRI or CT at least 1 month or longer from stroke onset were retrospectively included. We measured baseline lesion size on DWI and T2/fluid-attenuated inversion recovery (FLAIR) and follow-up lesion size on T2/FLAIR and CT. Follow-up MRI and CT images were assessed for cavity formation. Predictors for cavitation were assessed in a multivariate model. RESULTS: We identified 75 patients with lacunar infarction and follow-up CT or MRI, done 20.2 ± 16.6 and 21.2 ± 17.4 months after stroke, respectively. Mean baseline DWI size was 13.5 ± 5.7 and T2/FLAIR size was 13.1 ± 5.3 mm. Follow-up T2/FLAIR lesion size was 8.2 ± 3.4 mm and smaller than baseline DWI and T2/FLAIR (p = <0.001). Follow-up whole lesion size on CT scan was 7.1 ± 4.1 and smaller than baseline DWI and T2/FLAIR (p = 0.001). Cavitation occurred in 23/38 (61%) MRI and 50/70 (70%) CT scans. We identified periventricular white matter lesions as a predictor of cavity formation by MRI and CT. CONCLUSION: Acute DWI significantly overestimates final infarct size. A third of lacunar infarcts do not develop a cavity.
BACKGROUND: In acute lacunar infarction, MRI may overestimate eventual infarct size and the imaging evolution of acute lesions is not fully understood. Our objective was to examine eventual infarct size, the incidence of cavity formation, and factors associated with cavitation in patients presenting with acute lacunar infarction. METHODS:Patients with acute diffusion-weighted imaging (DWI) infarcts ≤25 mm in diameter, in the distribution of a penetrating artery, who had a follow-up MRI or CT at least 1 month or longer from stroke onset were retrospectively included. We measured baseline lesion size on DWI and T2/fluid-attenuated inversion recovery (FLAIR) and follow-up lesion size on T2/FLAIR and CT. Follow-up MRI and CT images were assessed for cavity formation. Predictors for cavitation were assessed in a multivariate model. RESULTS: We identified 75 patients with lacunar infarction and follow-up CT or MRI, done 20.2 ± 16.6 and 21.2 ± 17.4 months after stroke, respectively. Mean baseline DWI size was 13.5 ± 5.7 and T2/FLAIR size was 13.1 ± 5.3 mm. Follow-up T2/FLAIR lesion size was 8.2 ± 3.4 mm and smaller than baseline DWI and T2/FLAIR (p = <0.001). Follow-up whole lesion size on CT scan was 7.1 ± 4.1 and smaller than baseline DWI and T2/FLAIR (p = 0.001). Cavitation occurred in 23/38 (61%) MRI and 50/70 (70%) CT scans. We identified periventricular white matter lesions as a predictor of cavity formation by MRI and CT. CONCLUSION: Acute DWI significantly overestimates final infarct size. A third of lacunar infarcts do not develop a cavity.
Authors: Marco Duering; Ruth Adam; Frank A Wollenweber; Anna Bayer-Karpinska; Ebru Baykara; Leidy Y Cubillos-Pinilla; Benno Gesierich; Miguel Á Araque Caballero; Sophia Stoecklein; Michael Ewers; Ofer Pasternak; Martin Dichgans Journal: J Cereb Blood Flow Metab Date: 2019-07-25 Impact factor: 6.200
Authors: Yunis Mayasi; Johanna Helenius; David D McManus; Richard P Goddeau; Adalia H Jun-O'Connell; Majaz Moonis; Nils Henninger Journal: J Neurol Neurosurg Psychiatry Date: 2017-05-27 Impact factor: 10.154
Authors: Daniela Pinter; Thomas Gattringer; Christian Enzinger; Thomas Seifert-Held; Markus Kneihsl; Simon Fandler; Alexander Pichler; Christian Barro; Sebastian Eppinger; Lukas Pirpamer; Gerhard Bachmaier; Stefan Ropele; Joanna M Wardlaw; Jens Kuhle; Michael Khalil; Franz Fazekas Journal: J Cereb Blood Flow Metab Date: 2018-05-08 Impact factor: 6.200
Authors: Shuhei Okazaki; Eva Hornberger; Martin Griebe; Achim Gass; Michael G Hennerici; Kristina Szabo Journal: Front Neurol Date: 2015-05-26 Impact factor: 4.003
Authors: Hana Malikova; Karin Kremenova; Petr Budera; Dalibor Herman; Jiri Weichet; Jiri Lukavsky; Pavel Osmancik Journal: Quant Imaging Med Surg Date: 2021-07
Authors: Joanna M Wardlaw; Eric E Smith; Geert J Biessels; Charlotte Cordonnier; Franz Fazekas; Richard Frayne; Richard I Lindley; John T O'Brien; Frederik Barkhof; Oscar R Benavente; Sandra E Black; Carol Brayne; Monique Breteler; Hugues Chabriat; Charles Decarli; Frank-Erik de Leeuw; Fergus Doubal; Marco Duering; Nick C Fox; Steven Greenberg; Vladimir Hachinski; Ingo Kilimann; Vincent Mok; Robert van Oostenbrugge; Leonardo Pantoni; Oliver Speck; Blossom C M Stephan; Stefan Teipel; Anand Viswanathan; David Werring; Christopher Chen; Colin Smith; Mark van Buchem; Bo Norrving; Philip B Gorelick; Martin Dichgans Journal: Lancet Neurol Date: 2013-08 Impact factor: 44.182