Correlation between diffusion- and perfusion-weighted MRI and neurologicaldeficit measured by the Scandinavian Stroke Scale and Barthel Index in hyperacute subcortical stroke (<= 6 hours)

Objective: We used combined diffusion-weighted (DWI) and perfusion-weighted (PWI) MRI to characterize hyperacute infarctions within 6 h of symptom ons et with special reference to subcortical infarctions, and investigated the relation between perfusion-diffusion mismatch volume and functional outcome . Material and Methods: Twenty-two patients presenting with symptoms of acu te stroke underwent DWI and PWI within 6 h of symptom onset, and follow-up MRI 30 days later. Twelve of these had a subcortical infarction on acute DW I. Lesion volumes were measured by acute DWI and PWI as well as chronic T-2 -weighted MRI (T2WI). Clinical severity was measured by the Scandinavian St roke Scale (SSS) and the Barthel Index (bI). Results: In the 12 patients wi th subcortical infarctions, PWI and especially DWI correlated strongly with acute and chronic neurological SSS score, as well as with final infarct vo lume. Furthermore, a hyperacute PWI/DWI mismatch in this subgroup predicted lesion growth. There was a weaker correlation between acute DWI/PWI and ne urological score among all 22 patients, and patients with a PWI/DWI mismatc h larger than 100 ml had a significantly larger lesion growth and a poorer outcome than patients with a smaller mismatch. Conclusions: Subcortical inf arctions may represent a sizeable subgroup of acute stroke patients. Also s ubcortical infarctions may have a PWI/DWI mismatch and therefore may respon d to neuroprotective/ thrombolytic therapy. Hyperacute DWI may reflect the acute clinical status and predict the outcome in patients with subcortical infarction. Copyright (C) 2001 S. Karger AG, Basel.