De. Saunders et al., MEASUREMENT OF INFARCT SIZE USING MRI PREDICTS PROGNOSIS IN MIDDLE CEREBRAL-ARTERY INFARCTION, Stroke, 26(12), 1995, pp. 2272-2276
Background and Purpose An accurate measure of the severity of ischemic
insult and the resulting prognosis is needed to assess the effectiven
ess of new treatments for acute stroke. We studied the reproducibility
and accuracy of measurements of infarct volume with MRI and correlate
d the measurements with outcome.Methods Infarct volume was measured on
T-2-weighted images with the ANALYZE image analysis software. This te
chnique was found to be highly accurate and reproducible. Results Meas
urements of infarct volume were found to be highly accurate and reprod
ucible. Twenty-one patients (mean age, 66.5 years; range, 28 to 90 yea
rs) with cortical middle cerebral artery territory infarcts in whom ad
equate data could be obtained were studied within 72 hours from onset
(mean delay to MRI, 27.5 hours; range, 5 to 72 hours). The Scandinavia
n Stroke Scale was used to calculate a prognostic score, and clinical
outcome was assessed at 3 months. Infarct volume was found to signific
antly predict outcome. Mean infarct volume in the independent patients
was 35.7+/-29.7 cm(3) compared with 88.3+/-71.3 cm(3) in dependent pa
tients and cm 166.5+/-65.9 cm(3) in dead patients (F=10.52, P<.001). P
atients with an initial infarct volume less than 80 cm(3) were found t
o have a better outcome than those with larger infarct volumes. Second
ary hemorrhage visible on MRI also predicted a poor outcome. In contra
st, the Scandinavian Stroke Scale did not significantly predict outcom
e. Conclusions The results demonstrate that measurement of the size of
middle cerebral artery infarction with MRI is a useful tool in assess
ing prognosis and will have a valuable role in assessing new therapeut
ic agents.