Clinicoradiological Correlation of Infarct Patterns on Diffusion-weighted Magnetic Resonance Imaging in Stroke.

Zainab Hussain,Muhammad Bilal,Zafar Sajjad,Kiran Hilal,Raza Sayani

doi:10.7759/cureus.2260

Abstract

Diffusion-weighted magnetic resonance imaging (DW-MRI) represents a major advance in the early diagnosis of acute ischemic stroke. It can detect edema due to ischemia in the brain tissue. It not only establishes the presence and location of ischemic brain injury but also a relatively new concept is the determination of infarct patterns seen on diffusion imaging and its clinical correlation.ObjectiveTo determine the frequency of various infarct patterns and their relationship with functional outcome of the patient.Materials and methodsA total of 108 patients with acute stroke were enrolled by purposive sampling. Magnetic resonance imaging (MRI) was obtained with departmental protocol and diffusion-weighted sequences. The clinical data was collected from medical records and functional outcome was assessed at the time of admission using Barthel Index (BI) which was dichotomized into poor and favorable outcomes. The radiological data was collected and three infarct patterns (cortical, subcortical, and territorial infarcts) were recorded from diffusion-weighted images. Association of other risk factors such as age, gender, diabetes, hypertension (HTN), hyperlipidemia, and smoking were also evaluated.ResultsAmongst the three infarct patterns, subcortical infarcts were noted with the highest proportion of 62% (67/108). The highest proportion of territorial infarcts (78.6%) was significantly associated with a poor outcome in comparison to cortical and subcortical infarcts. Cortical infarcts (61.5%) were significantly associated with good outcomes followed by subcortical and then territorial infarcts (p-value < 0.002). Amongst the risk factors, HTN was found to be highly prevalent followed by diabetes mellitus (DM).ConclusionSubcortical infarct pattern was the most common, followed by territorial and cortical infarct. The highest proportion of infarct pattern with good outcomes was seen with cortical infarcts followed by subcortical and then territorial infarct pattern. HTN and coronary artery disease (CAD) were the effect modifiers showing significant association with poor outcomes.

Highlights

Stroke is one of the major causes of disability and death worldwide
The clinical data was collected from medical records and functional outcome was assessed at the time of admission using Barthel Index (BI) which was dichotomized into poor and favorable outcomes
Amongst the three infarct patterns, subcortical infarcts were noted with the highest proportion of 62% (67/108)

Summary

Introduction

Stroke is one of the major causes of disability and death worldwide. While the developed world has recognized the disease burden and it risk factors in countries such as India, Pakistan, Bangladesh, and Sri Lanka, there is a constant rise in mortality, with the increasing incidence of hypertension (HTN) being the primary cause [1]. Pakistan is predicted to be the fourth most populous country with diabetes mellitus (DM) by 2020 [2]. Every third urban Pakistani above 45 years is diagnosed with HTN [3]. Due to the lack of sufficient economic resources and health awareness, despite timely diagnosis of hypertension, uncontrolled disease is prevalent. The Pakistan Stroke Society gives an estimated incidence of 250 per 100,000 which means that there are 350,000 new stroke cases per year [2]

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