, Volume 48, Issue 9, pp 632-639

Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis

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Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M1–2 segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis.


Initial infarct volume (VDWI-I ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum VDWI-I still associated with a good clinical outcome, the patients were divided into two groups (VDWI-I ≤70 ml and >70 ml).


VDWI-I ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a VDWI-I ≤70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a VDWI-I >70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026).


Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a VDWI-I ≤70 ml had a significantly better outcome.

This paper was presented in part as a lecture at the 9th Congress of the European Federation of Neurological Societies Athens, Greece, 17–20 September 2005.