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Evolution of the diffusion-weighted signal and the apparent diffusion coefficient in the late phase after minor stroke

A follow-up study

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Abstract

Introduction

Diffusion-weighted imaging (DWI) is mainly used in acute stroke, and signal evolution in the acute phase has been studied extensively. However, patients with a minor stroke frequently present late. Recent studies suggest that DWI may be helpful at this stage, but only very few published data exist on the evolution of the DW-signal in the weeks and months after a stroke. We performed a follow-up study of DWI in the late stages after a minor stroke.

Methods

28 patients who presented 48 hours to 14 days after a minor stroke underwent serial MRI at baseline, 4 weeks, 8 weeks, 12 weeks, 6 months and ≥9 months after their event. Signal intensity within the lesion was determined on T2-weighted images, DW-images and the Apparent Diffusion Coefficient (ADC) map at each time-point, and ratios were calculated with contralateral normal values (T2r, DWIr, ADCr).

Results

T2r was increased in all patients from the beginning, and showed no clear temporal evolution. ADCr normalized within 8 weeks in 83% of patients, but still continued to increase for up to 6 months after the event. The DW-signal decreased over time, but was still elevated in 6 patients after ≥6 months. The evolution of ADCr and DWIr showed statistically highly significant inter-individual variation (p < 0.0001), which was not accounted for by age, sex, infarct size or infarct location.

Conclusion

The ADC and the DW-signal may continue to evolve for several months after a minor ischaemic stroke. Signal evolution is highly variable between individuals. Further studies are required to determine which factors influence the evolution of the ADC and the DW-signal.

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Acknowledgements

Dr Schulz was funded by The Wellcome Trust. Dr Flossmann was funded by the UK Medical Research Council. Conflict of Interest: None.

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Authors and Affiliations

  1. Dept. of Clinical, Stroke Prevention Research Unit, University of Neurology, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, United Kingdom

    U.G.R. Schulz, E. Flossmann, J.N. Redgrave & P.M. Rothwell

  2. Centre for Clinical Magnetic Resonance Research. (OCMR), University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom

    J.M. Francis

Authors
  1. U.G.R. Schulz
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  2. E. Flossmann
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  3. J.M. Francis
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  4. J.N. Redgrave
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  5. P.M. Rothwell
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Correspondence to P.M. Rothwell.

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Received in revised form: 14 April 2006

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Schulz, U., Flossmann, E., Francis, J. et al. Evolution of the diffusion-weighted signal and the apparent diffusion coefficient in the late phase after minor stroke. J Neurol 254, 375–383 (2007). https://doi.org/10.1007/s00415-006-0381-y

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  • DOI: https://doi.org/10.1007/s00415-006-0381-y

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