Abstract
Background: Knowing which areas of the brain are most vulnerable to acute ischemic stroke can focus care on more effective, targeted therapies. By displaying lesion incidence, these susceptible regions are clearly illustrated and can be correlated with characteristics common to that population. While previous studies created DWI lesion atlases, we aimed to map the spatio-temporal topology of multi-modal MRI sequences from a large cohort of stroke patients onto a standard atlas coordinate system. Methods: Pre-treatment ADC and perfusion-weighted imaging (PWI) and post-treatment FLAIR MRI sequences for 241 acute ischemic stroke patients which were retrospectively processed. Lesion locations were circumscribed semi-automatically on the ADC and FLAIR images. Perfusion parameters were extracted from the PWI images using Bayesian hemodynamic parameter estimation. To account for anatomical variation, custom software was created to co-register the MRIs onto an atlas. Decomposing by NIHSS score items, the software then created probabilistic maps by overlaying and averaging the subgroup’s lesions and parameters within the atlas. Results: An multi-dimensional set of annotated, co-registered stroke images for ADC, PWI and FLAIR sequences was established. Incidence maps based on NIHSS score items displayed anatomic localization of presenting symptoms in various imaging modes, before and after reperfusion or other therapies (Figure). A software suite was produced that co-registers, atlases, and calculates incidence maps for any set of images. Conclusions: A framework to obtain spatial incidence maps was applied to ADC, PWI and FLAIR MRI of ischemic stroke. This instrument can co-register any annotated imaging parameters and compute lesion maps for any metric of interest. This novel atlasing method may be used to elucidate stroke etiology, predict lesion progression and identify optimal treatments based on individual imaging features at presentation.
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