Association of Ischemic Lesion Patterns on Early Diffusion-Weighted Imaging With TOAST Stroke Subtypes

Abstract

Early DWI lesion patterns are associated with specific stroke causes. Conventional 15-mm criteria for lacunes, however, may underestimate the diagnosis of small-vessel occlusion with DWI.

Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke

“…A clinical and imaging prediction model may be useful to determine which high-risk patients should receive extended electrocardiogram monitoring. In keeping with previous studies which reported an association between territorial infarcts and cardioembolic stroke, we also found that territorial infarcts were highly associated with newly detected AF in this study ( 12 , 18 – 20 ). For acute stroke caused by large vessel occlusion, cardioembolic stroke tends to have less collateral flow compared with atherosclerotic stroke because of the more abrupt perfusion compromise in cardioembolic occlusion ( 21 , 22 ).…”

“…The infarction pattern of single subcortical infarcts with a diameter <20 mm, commonly called lacunar infarcts, was less likely to be associated with newly detected AF in this study, which is comparable with previous reports (12,27). A single subcortical infarct with a diameter ≥20 mm still showed a non-significant trend toward identifying the absence of AF.…”

Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke

“…A clinical and imaging prediction model may be useful to determine which high-risk patients should receive extended electrocardiogram monitoring. In keeping with previous studies which reported an association between territorial infarcts and cardioembolic stroke, we also found that territorial infarcts were highly associated with newly detected AF in this study ( 12 , 18 – 20 ). For acute stroke caused by large vessel occlusion, cardioembolic stroke tends to have less collateral flow compared with atherosclerotic stroke because of the more abrupt perfusion compromise in cardioembolic occlusion ( 21 , 22 ).…”

“…The infarction pattern of single subcortical infarcts with a diameter <20 mm, commonly called lacunar infarcts, was less likely to be associated with newly detected AF in this study, which is comparable with previous reports (12,27). A single subcortical infarct with a diameter ≥20 mm still showed a non-significant trend toward identifying the absence of AF.…”

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

“…However, 66.7% of patients with CE and 83.3% of patients with peri-procedural infarction who underwent cardiovascular surgery had lesions distributed in both supratentorial and infratentorial areas. The results suggest that cardiac-derived or aortic arch-derived emboli should be firstly considered when lesions are located in both the supra-and infra-tentorial regions, which is in line with a previous study (24)(25)(26)(27). On the contrary, in most patients with AMIMCT concomitant with autoimmune diseases, the disease tended to present with supratentorial infarctions.…”

Lesion Patterns on Early Diffusion-weighted Magnetic Resonance Imaging and Ischemic Stroke Subtypes

“…We detected diffuse scattered lesions in one vascular area in the LAA group at a higher rate. Our result was concordant with previous studies (6,8,11,14,15). The presence of either "string of pearls" or "scattered pearls" on MRI was found to be associated with an independently determined mechanism of intracranial or extracranial arterial stenosis (16,17).…”

Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke

“…A clinical and imaging prediction model may be useful to determine which high-risk patients should receive extended electrocardiogram monitoring. In keeping with previous studies which reported an association between territorial infarcts and cardioembolic stroke, we also found that territorial infarcts were highly associated with newly detected AF in this study ( 12 , 18 – 20 ). For acute stroke caused by large vessel occlusion, cardioembolic stroke tends to have less collateral flow compared with atherosclerotic stroke because of the more abrupt perfusion compromise in cardioembolic occlusion ( 21 , 22 ).…”

“…The infarction pattern of single subcortical infarcts with a diameter <20 mm, commonly called lacunar infarcts, was less likely to be associated with newly detected AF in this study, which is comparable with previous reports (12,27). A single subcortical infarct with a diameter ≥20 mm still showed a non-significant trend toward identifying the absence of AF.…”

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

“…However, 66.7% of patients with CE and 83.3% of patients with peri-procedural infarction who underwent cardiovascular surgery had lesions distributed in both supratentorial and infratentorial areas. The results suggest that cardiac-derived or aortic arch-derived emboli should be firstly considered when lesions are located in both the supra-and infra-tentorial regions, which is in line with a previous study (24)(25)(26)(27). On the contrary, in most patients with AMIMCT concomitant with autoimmune diseases, the disease tended to present with supratentorial infarctions.…”

Lesion Patterns on Early Diffusion-weighted Magnetic Resonance Imaging and Ischemic Stroke Subtypes

“…We detected diffuse scattered lesions in one vascular area in the LAA group at a higher rate. Our result was concordant with previous studies (6,8,11,14,15). The presence of either "string of pearls" or "scattered pearls" on MRI was found to be associated with an independently determined mechanism of intracranial or extracranial arterial stenosis (16,17).…”

Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke

“…A clinical and imaging prediction model may be useful to determine which high-risk patients should receive extended electrocardiogram monitoring. In keeping with previous studies which reported an association between territorial infarcts and cardioembolic stroke, we also found that territorial infarcts were highly associated with newly detected AF in this study ( 12 , 18 – 20 ). For acute stroke caused by large vessel occlusion, cardioembolic stroke tends to have less collateral flow compared with atherosclerotic stroke because of the more abrupt perfusion compromise in cardioembolic occlusion ( 21 , 22 ).…”

“…The infarction pattern of single subcortical infarcts with a diameter <20 mm, commonly called lacunar infarcts, was less likely to be associated with newly detected AF in this study, which is comparable with previous reports (12,27). A single subcortical infarct with a diameter ≥20 mm still showed a non-significant trend toward identifying the absence of AF.…”

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

“…However, 66.7% of patients with CE and 83.3% of patients with peri-procedural infarction who underwent cardiovascular surgery had lesions distributed in both supratentorial and infratentorial areas. The results suggest that cardiac-derived or aortic arch-derived emboli should be firstly considered when lesions are located in both the supra-and infra-tentorial regions, which is in line with a previous study (24)(25)(26)(27). On the contrary, in most patients with AMIMCT concomitant with autoimmune diseases, the disease tended to present with supratentorial infarctions.…”

Lesion Patterns on Early Diffusion-weighted Magnetic Resonance Imaging and Ischemic Stroke Subtypes

“…We detected diffuse scattered lesions in one vascular area in the LAA group at a higher rate. Our result was concordant with previous studies (6,8,11,14,15). The presence of either "string of pearls" or "scattered pearls" on MRI was found to be associated with an independently determined mechanism of intracranial or extracranial arterial stenosis (16,17).…”