CT sign of brain swelling without concomitant parenchymal hypoattenuation: comparison with diffusion- and perfusion-weighted MR imaging

PURPOSE: To retrospectively evaluate the apparent diffusion coefficient (ADC) on magnetic resonance (MR) images and the perfusion parameters of lesions that show brain swelling without concomitant parenchymal hypoattenuation on computed tomographic (CT) scans. MATERIALS AND METHODS: Review board approval was obtained, and informed consent was waived. A total of 14 patients (seven men and seven women; mean age, 64 years +/- 11) were retrospectively selected from the consecutive 172 patients with acute cerebral ischemia who underwent CT within 6 hours of symptom onset. All patients had brain swelling without parenchymal hypoattenuation, including loss of gray-white matter distinction on CT scans, and they underwent diffusion- and perfusion-weighted MR imaging shortly after CT. CT attenuation, ADC, and perfusion parameters of relative cerebral blood volume (CBV), time to peak (TTP), and relative cerebral blood flow (CBF) were calculated for gray and white matter of the lesion. The measured values were compared with those of the contralateral hemisphere by using the paired t test; comparison of values of perfusion parameters among three subgroups was performed with the Kruskal-Wallis test. Arterial occlusions were determined with MR angiography or conventional angiography. RESULTS: The mean interval between initial CT and MR imaging was 2.4 hours +/- 0.9 (range, 0.4-3.4 hours). The ADC of lesions was similar to that of contralateral normal tissue (mean ADC ratio for gray matter and white matter, 0.99 and 0.97, respectively) (P > .05). Lesions had an increased relative CBV (P < .001), a mild to moderate TTP delay (P < .001), and a variable but not statistically significant reduction of relative CBF. The mean relative CBF of gray matter was less in patients who had complete infarction (0.81 +/- 0.16) than that in patients with partial infarction (0.99 +/- 0.16) or those with a normal radiologic outcome (1.12 +/- 0.22), but this difference was not statistically significant (P > .05). Proximal cerebral artery occlusions were found in all patients. In five (36%) patients, the lesion did not progress to infarction at follow-up. CONCLUSION: The CT sign of brain swelling without concomitant parenchymal hypoattenuation in patients with acute cerebral ischemia does not represent severe ischemic damage and may suggest ischemic penumbral or oligemic tissue.     

急性期脑内血肿3.0T MR扩散加权成像表现

目的:探讨3.0T MR设备中平面回波扩散加权成像(EPI-DWI)和表观扩散系数(ADC)图对急性脑内血肿的诊断价值及与脑梗死的鉴别诊断能力。方法:对18例急性期脑内血肿患者行EPI-DWI检查,获得ADC图并与CT及常规MRI进行对比。同期选择发病时间、病变体积相近的急性脑梗死患者18例,比较急性期脑内血肿与脑梗死的MRI表现。结果:所有急性期脑内血肿在EPI-DWI及ADC图上均为混杂信号,尤其是较大血肿;不同大小血肿周边均可见低信号环。所有急性脑梗死病变均未见周边环状低信号。结论:血肿周边低信号环为急性期脑内血肿的特异性DWI表现,可资与急性脑梗死相鉴别。     

Prediction of hemorrhagic transformation in acute ischemic stroke: role of diffusion-weighted imaging and early parenchymal enhancement

BACKGROUND AND PURPOSE: MR imaging may help in predicting hemorrhagic transformation (HT) in acute ischemic stroke. Our purpose was to determine whether the lesion volumes on diffusion-weighted (DW) imaging, apparent diffusion coefficient (ADC) values, and early parenchymal enhancement are predictive of HT and to investigate the mechanism of the enhancement. METHODS: We retrospectively examined 55 patients with acute ischemic stroke who underwent gadolinium-enhanced MR imaging within 6 hours of symptom onset and follow-up CT or MR imaging within 72 hours. Intravenous thrombolysis was performed in 15 patients. DW imaging lesion volumes and ADC values were compared between patients with and those without HT. ADCs and perfusion parameters were compared between lesions with and those without parenchymal enhancement. RESULTS: Nineteen (34.5%) patients had HT (14 with hemorrhagic infarction, five with parenchymal hematoma). Patients with HT had decreased mean ADCs and large lesion volumes on DW imaging, but differences were not significant (P > .05). HT occurred in five patients (100%) with parenchymal enhancement, which corresponded to the site of HT. In enhancing lesions, the ADC ratio (0.76 +/- 0.06) was slightly higher and the delay in time to peak (0.10 +/- 2.79) was less than respective values in the rest of the ischemic lesion (0.66 +/- 0.06 and 8.79 +/- 4.86, respectively; P = .068). CONCLUSION: Early parenchymal enhancement is highly specific for HT and may be associated with early reperfusion and damage to the blood-brain barrier in ischemic tissue. DW imaging lesion volumes and ADC values had no strong relationship with HT.     

DWI findings of periventricular ischemic changes in patients with leukoaraiosis.

In this report the diffusion-weighted imaging (DWI) findings and ADC values of leukoaraiosis (LA) and associated periventricular ischemic lesions were assessed. Seventy-eight patients with LA were examined with magnetic resonance imaging (MRI) and DWI. Twenty one patients (28%) were found to have focal acute white matter infarction on DWI which could not be detected and discriminated on the basis of MRI findings alone. LA and acute white matter infarction both showed hyperintensity on standard T2W MRI, whereas acute infarction revealed focal hyperintensity on DWI. Thirteen patients (16%) had chronic lacunar infarctions in the white matter. ADC values of LA, acute and chronic white matter infarctions were calculated and found to be significantly different from each other (p<0.05). It is concluded that DWI is necessary in the detection of acute periventricular white matter infarction from LA.     

大鼠超急性期脑缺血的磁共振扩散加权成像研究

目的：利用磁共振扩散加权成像（DWI）评价大鼠超急性期脑缺血的诊断价值。方法：12只Wistar雄性大鼠,采用线栓法制作右侧大脑中动脉闭塞（MCAO）脑缺血模型,分别于栓塞后1h和6h行大鼠冠状位磁共振DWI、T2WI和T1WI检查,并测量缺血区DWI异常高信号的体积、表观扩散系数（ADC）值,将所测值进行比较。磁共振检查结束后处死大鼠,断头取脑行TTC染色,并与DWI结果进行比较。结果：大鼠MCAO后1h进行MRI扫描右侧大脑中动脉供血区DWI可见异常稍高信号,ADC为低信号,T2WI和T1WI均未见异常信号;MCAO后6hDWI可见明显高信号,较1hADC值显著减低（P〈0.01）,DWI上梗死灶体积显著扩大（P〈0.01）,T2WI显示缺血区异常高信号,T1WI可见稍低信号。TTC染色者均显示脑梗死灶,与MCAO后6h的DWI显示脑缺血范围一致。结论：DWI对超急性期脑梗死较常规MRI敏感,是超急性期脑缺血重要的检查方法。     

高血压脑病的MRI表现

目的 分析高血压脑病的MRI表现。资料与方法 搜集8例经临床诊断高血压脑病患者,行MR T1WI和T2WI检查,其中4例加行扩散加权成像（DWI）,分析血压变化、MRI表现及ADC值变化。结果 发病时平均血压199．63／123．5mmHg（1mmHg=0．133kPa）,平均升高25．73％／28．71％。MRI上病变主要呈TI稍低、T2稍高信号,以顶枕叶、小脑半球多见。DWI病变呈等及稍高信号,ADC值较正常平均升高58％。仅1个病灶DWI出现明显高信号,ADC值减低。结论 MRI有助于高血压脑病的诊断及鉴别诊断、预后及疗效观察,DWI是将其与急性脑梗死区分开的最佳影像学检查方法。     

Association of early CT abnormalities, infarct size, and apparent diffusion coefficient reduction in acute ischemic stroke

BACKGROUND AND PURPOSE: Diffusion-weighted (DW) imaging is more sensitive for early ischemia than CT, and apparent diffusion coefficient (ADC) mapping permits quantification of the severity of cytotoxic edema. We examined the relationship between early CT findings, ischemic lesion volume on DW images, and edema subtype. METHODS: Patients in whom early signs of ischemia were detected on baseline CT scans were scored CT positive. Baseline DW lesion volumes were compared between the CT-positive and CT-negative patients. In CT-positive patients, we outlined the CT-positive part of the DW lesion and transferred these regions of interest to the corresponding DW sections. The ADC values of the outlined CT-positive areas were then compared with the ADC values of the CT-negative areas within patients. Lesions with significantly increased T2 hyperintensity were excluded to correct for the effect of early vasogenic edema on ADC measurements. RESULTS: Twenty-four patients with cerebral ischemia in whom both CT and DW imaging were performed within 8 hours of symptom onset were entered into the study. Patients with early CT signs of infarction (n = 12) had significantly larger DW lesion volumes than did patients without early CT abnormalities (mean volume, 62.8 versus 14.6 mL; P =. 002). In patients displaying early CT abnormalities, CT-positive regions of the DW lesion had lower relative ADC (rADC) values than did the CT-negative regions, when lesions with significant T2 hyperintensity were excluded (mean rADC, 0.65 versus 0.75; P =.037). CONCLUSION: These findings support the hypothesis that early CT signs of infarction indicate more extensive and severe cerebral ischemia, as reflected by lower ADC.     

Eclamptic encephalopathy: MRI,including diffusion-weighted images

Eclampsia is a rare condition peculiar to pregnant and puerperal women. We analyse imaging features in five patients with eclampsia, and determine whether diffusion-weighted imaging (DWI) could differentiate cytotoxic and vasogenic oedema in four of them. All were imaged within 4 days of the onset of symptoms. We found lesions with a prolonged T2 in the brain of all five patients, in the basal ganglia in four, pons in three and posterior cerebral white matter in two. Isotropic DWI revealed variable intensity in these regions. The ADC was decreased in one, and increased in all the others. The lesion with reduced ADC progressed to infarction.     

低场强磁共振弥散成像在脑梗死诊断中的应用价值

目的 评价低场磁共振弥散序列对各期脑梗死的诊断作用。方法 应用磁共振T1W1，T2WI和水抑制反转恢复成像(T2 FLAIR)和DWI对70例各期脑梗死病人进行86人次MRI检查，并作ADC图，测定ADC值。结果在超急性脑梗死病例中，DWI和ADC图均表现缺血，但T2及T2FLAIR成像表现正常，病灶的ADC值随梗死时间延长，呈由低向高变化的趋势。结论低场磁共振DWI对急性期及超急性期脑缺血病变高度敏感，显示率及敏感性是100％．常规T2WI敏感性37％；ADC图可进一步量化缺血程度，二者结合应用对脑梗死的早期诊断和病灶的转归评估有重要意义。     

Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps

OBJECTIVE: The purpose of this study was to compare the incidence of large hypoperfusion (greater than two-thirds of MCA territory) on computed tomography (CT) perfusion maps between hyperacute middle cerebral artery (MCA) stroke patients without or with malignant cerebral edema. METHODS: Twenty-seven patients diagnosed with a hyperacute MCA stroke who had an initial National Institutes of Health Stroke Scale (NIHSS) score greater than 10 were included. Multiphasic perfusion CT was performed within 6 hours of symptom onset. Patients were divided into 2 groups: the malignant group (n = 11), composed of patients who died within 7 days, and the nonmalignant group, which included all other patients (n = 16). Unenhanced CT and CT perfusion maps were assessed and compared between the 2 groups with special emphasis on examining the CT findings, including hyperdense MCA sign, large (greater than two-thirds) hypoattenuation and hypoperfusion in the MCA territory, and hypoattenuation in the basal ganglia and other vascular territories. RESULTS: The incidence of large hypoattenuation (greater than two-thirds of MCA territory) on unenhanced CT and large hypoperfusion on CT perfusion maps differed significantly between the 2 groups (P < 0.05). Large hypoperfusion on the CT total perfusion map was most accurate (93%) among various CT findings for the prediction of malignant MCA infarction with high sensitivity (91%), specificity (94%), and positive predictive value (91%). CONCLUSIONS: The incidence of large hypoperfusion on a CT perfusion map was higher in the malignant group than the nonmalignant group. CT perfusion maps may provide added information about cerebral perfusion and could be a useful predictor of malignant MCA infarction.     

磁共振扩散加权成像在急性脑梗死中的临床应用价值

目的评价扩散加权成像(DW I)对急性脑梗死的诊断价值和限度。方法回顾性分析58例急性脑梗死患者的MR I检查资料,其中超急性期19例(<6 h),急性期24例(6~24 h),亚急性期15例(24~72 h)。均行FLAIR T1W I,FSE T2W I,FLAIRT2W I和SE-EPI DW I序列扫描。测定病灶ADC值和对侧镜像区ADC值作对照分析。6例行MRA检查。结果(1)58例DW I均显示相应神经体征分布区的梗死灶,明显优于FLAIR T1W I,FSE T2W I,FLAIR T2W I序列;(2)超急性期、急性期和亚急性期病灶ADC值均下降,各期病灶ADC值与对侧镜像区ADC值比较均有显著性差异(P<0.05),各期病灶侧ADC值两两相互比较均无显著性差异(P>0.05);(3)6例MRA中2例大脑中动脉(MCA)完全闭塞,4例MCA信号减低。结论DW I较常规序列发现急性脑梗死早,但根据ADC值或DW I的信号变化难以鉴别超急性期、急性期和亚急性期病灶。     

扩散加权成像诊断超急性和急性脑梗塞的应用价值

目的:探讨DWI和ADC图诊断超急性和急性脑梗塞的价值.材料和方法:14例脑梗塞患者(超急性期6例,急性期8例)采用1.5T MR机进行扫描,对DWI、ADC图及常规T1WI、T2WI进行对比研究分析.结果:超急性和急性脑梗塞DWI均表现为高信号,ADC图均表现为低信号,DWI对病变显示达100%.6例超急性期脑梗塞患者仅DWI可显示病变而常规T1WI、T2WI无任何相应的异常发现.全部病灶ADC值均低于其相对应的正常脑组织.结论:DWI对急性脑梗塞诊断敏感、准确,且能对脑梗塞作定量分析.     

急性脑静脉闭塞脑损伤治疗时间窗初探:DWI与病理学对照实验研究

目的:探讨急性脑静脉闭塞模型脑实质损伤治疗时间窗的存在及其意义.方法:选择新西兰大白兔28只随机分为2组(实验组24只,对照组4只),实验组动物经一侧颈内静脉注入醋酸纤维素聚合物(CAP),分别于术后1、3、6、12、24和48 h行T1WI、T2WI和扩散加权成像(DWI)检查.各时间点MR扫描后取兔脑组织做胶质纤维酸性蛋白(GFAP)表达的免疫组化研究及电镜观察.结果:DWI、T2WI、GFAP的表达和电镜检查均能显示急性脑静脉闭塞模型脑实质损伤及其变化.DWI在术后1 h即能显示脑实质病变(ADC值下降),术后3 h DWI和T2WI均能显示病变;术后6 h前,DWI上有扩散异常的脑组织容积明显大于T2WI上异常高信号区的容积(t=13.69,P＜0.01);术后12、24和48 h病变区ADC值逐渐回升,T2WI上病变容积与DWI上的扩散异常区的容积比较,差异无显著性意义(t值分别为1.467、0.996和2.017,P＞0.05).术后1 h病变区GFAP阳性细胞增多,染色加深,胞体增大,突起增粗增长,术后3～6 h变化更明显,病理学改变以血管源性水肿为主,12 h后出现脑组织大量坏死.对照组未见上述各种异常表现.结论:DWI可准确评价急性脑静脉闭塞模型脑实质损伤程度,结合GFAP的表达,在探讨急性脑静脉闭塞脑损伤的治疗时间窗的存在及其意义中具有重要价值,在其发生发展过程中确实存在潜在的治疗时间窗.     

Utility of CT perfusion with 64-row multi-detector CT for acute ischemic brain stroke

We investigated the utility of computed tomographic (CT) perfusion (CTP) with 64-row multi-detector row CT (MDCT) to diagnose acute infarction and ischemic penumbra. We reviewed 58 clinical cases with acute ischemic stroke with CTP, compared the size of the area with long mean transit time (MTT) to that with abnormal intensity in magnetic resonance (MR) diffusion-weighted imaging (DWI) to diagnose penumbra, and compared the size of the area with reduced cerebral blood volume (CBV) in CTP to that in MR DWI to evaluate sensitivity for infarction. The total sensitivity of MTT to acute ischemic lesions was 81% (47/58). Sensitivity of MTT to segmental lesions was 100% (42/42) and for spot and focal lesions, 31% (5/16). In 13 patients, penumbra was diagnosed as lesions mismatched between MTT in CTP and MR DWI. When we regarded a lesion with decreased CBV as infarction, the sensitivity of CBV to segmental lesions was 85% (11/13), and the sensitivity to small infarction was 14% (4/28). Use of 64-row MDCT improves coverage and radiation exposure in head CTP. The combination of plain CT, CT angiography, and CTP with MDCT can demonstrate all segmental ischemic lesions and most large segmental infarctions, and their combined application is useful in considering indication and contraindication for thrombolysis. The problem of low sensitivity for small lesions remains, and MR DWI may be required to assess small infarctions when findings from combined plain CT, CT angiography, and CTP are negative in patients with suspected acute brain stroke.     

Vascular occlusion sites determine differences in lesion growth from early apparent diffusion coefficient lesion to final infarct

BACKGROUND AND PURPOSE: Occlusion of major cerebral arteries is the primary source of tissue damage in ischemic stroke and the target of thrombolytic therapy. We hypothesized that large infarcts in more proximal vascular occlusions correspond with substantially increased ischemic lesions shown on initial apparent diffusion coefficient (ADC) maps. METHODS: Initial ADC lesions in 120 patients with acute ischemic stroke were analyzed within 6 hours of stroke onset. Patients were categorized on the basis of vascular occlusion, as shown on MR angiography. Lesion volumes were determined by using manual delineation (ADC(man)) and a threshold method for ADC values (<550 x 10(-9) mm(2)/s(-1), ADC(<550)). Infarct volumes were analyzed by using T2-weighted (n = 109) or CT (n = 11) images obtained on days 5-8. RESULTS: Median lesion volumes for ADC(<550), ADC(man), and infarcts, respectively, were as follows: proximal internal carotid artery (ICA)/middle cerebral artery (MCA) occlusions, 10, 23, and 32 cm(3); carotid-T occlusions, 11, 37, and 138 cm(3); MCA trunk occlusions, 11, 27, and 44 cm(3)); and MCA branch occlusions 8, 27, and 21 cm(3). Initial ADC lesion volumes were different only between the carotid T and the MCA branch (P < .05). On days 5-8, infarct volumes decreased from proximal to distal sites (P < .05), with the exception of MCA trunk versus proximal ICA/MCA occlusions. Recanalization rate in carotid-T occlusion was significantly lower than those of all other occlusion types. CONCLUSION: Initial ADC lesions can be small, even in patients with proximal vascular occlusions. These patients develop considerably large infarctions, suggesting a high potential for infarct growth. This growth might be averted with improved early recanalization of proximal vascular occlusions.     

Identifying lesion growth with MR imaging in acute ischemic stroke

PURPOSE: To determine whether different MR diffusion- and perfusion-weighted imaging (DWI and PWI) parameters are important in distinguishing lesion growth from the acute lesion and from oligemia. MATERIALS AND METHODS: MR DWI and PWI were acquired from thirteen patients. We defined three regions: (i) LESION - intersection of acute and final lesions, (ii) GROWTH - portion of final lesion not part of acute lesion, and (iii) OLIGEMIA - region of perfusion abnormality not part of either the acute or final lesions. We used logistic regression modeling to distinguish GROWTH from LESION and from OLIGEMIA on a voxel-wise basis using DWI- and PWI-based parameters. Final models were selected based on the Wald statistic and validated by cross-validation using the mean (+/- standard deviation) area under the curve (AUC) from receiver operating characteristic analysis. RESULTS: The final model for differentiating GROWTH from LESION included DWI, the apparent diffusion coefficient (ADC), cerebral blood flow (CBF) and tissue type (AUC = 0.939 +/- 0.028). The final model for differentiating GROWTH from OLIGEMIA included DWI, ADC, CBF, and time-to-peak (AUC = 0.793 +/- 0.106). CONCLUSION: Different MR parameters are important in differentiating lesion growth from acute lesion and from oligemia in acute ischemic stroke.     

表观弥散系数在高级别胶质瘤与急性期脑梗死鉴别诊断中的应用

目的探讨表观弥散系数(ADC值)在高级别胶质瘤与急性期脑梗死鉴别诊断中的应用。方法回顾性分析经手术和病理证实的18例高级别胶质瘤及正规及时溶栓治疗的28例急性期脑梗死的常规磁共振表现和弥散加权成像(DWI)表现,对照分析高级别胶质瘤实性部分、急性期脑梗死灶中心部分及对侧正常脑组织ADC值。结果 18例高级别胶质瘤患者共发现20个病灶,其中11例病灶内合并有出血、坏死和囊变,肿瘤实质部分呈稍高信号,囊变坏死区呈明显低信号,肿瘤实质部分平均ADC值为(0.92±0.12)×10-3mm2/s,对侧相应正常部位平均ADC值为(0.79±0.09)×10-3mm2/s,差异有统计学意义(P<0.05),急性期脑梗死在DWI上表现为高或稍高信号,其ADC值明显低于对侧相应区域,平均ADC值为(0.69±0.10)×10-3mm2/s,高级别胶质瘤实性部分与急性期脑梗死平均ADC值差异有统计学意义(P<0.05)。结论 DWI表现及ADC值对高级别胶质瘤与急性期脑梗死磁共振鉴别诊断具有重要价值。     

急性大脑中动脉阻塞模型的磁共振弥散成像及相关病理基础研究

目的观察兔大脑中动脉阻塞后常规MRI及DWI表现,阐明活体脑缺血后DWI的演变规律及其病理生理机制方法40只成年新西兰大白兔随机分成2组,对照组4只,实验组36只实验组采用Yamamoto法制作急性大脑中动脉阻塞(MCAO)模型,对照组仅曝露大脑中动脉,而不结扎观察MCAO后缺血区在各时段ADC值的变化规律,并进行病理学检查结果对照组:T2WI及DWI均无高信号出现,光镜检查均无异常改变实验组:DWI上,MCAO后0.5h基底节区出现高信号;T2WI最早于2h出现高信号,早期ADC值快速下降的病理基础是缺血后细胞内的水含量的增加;ADC值下降减慢及相对平台期的病理基础是血脑屏障破坏的逐渐加重及血管源性水肿的出现;而ADC值的上升的病理基础是细胞的死亡、溶解,血脑屏障的破坏结论早期的扩散异常区域并不意味着病灶已发生梗死,当持续缺血达6h以上,脑组织将产生不可逆的损伤     

弥散加权MRI在脑梗塞诊断中的初步应用

目的：探讨弥散加权ＭＲＩ（ＤＷＩ）对早期脑梗塞诊断的敏感性和对急性与非急性脑梗塞的鉴别诊断价值。材料和方法：３１例脑梗塞（４例超急性,７例急性,１２例亚急性,８例慢性）患者行头颅单次激发回波平面弥散加权ＭＲＩ和常规ＭＲＩ扫描。结果：超急性、急性和亚急性脑梗塞在ＤＷＩ上均表现为高信号,其中４例超急性脑梗塞常规ＭＲＩ阴性。慢性脑梗塞除１例（发病１５天）ＤＷＩ表现为高信号,其余表现为混杂信号、等信号或低信号。６例患者常规ＭＲＩ显示多发脑梗塞灶,但ＤＷＩ显示１个急性高信号病灶。结论：ＤＷＩ对急性脑梗塞,尤其是超急性脑梗塞较常规ＭＲＩ具有更高的敏感性;ＤＷＩ还可以鉴别急性和非急性脑梗塞。     

Development of brain infarct volume as assessed by magnetic resonance imaging (MRI): follow-up of diffusion-weighted MRI lesions

PURPOSE: To investigate the development of ischemic brain lesions, as present in the acute stroke phase, by diffusion-weighted magnetic resonance imaging (DWI), and in the subacute and chronic phases until up to four months after stroke, in fluid-attenuated inversion recovery (FLAIR)- and T2-weighted (T2W) magnetic resonance (MR) images. MATERIALS AND METHODS: Twelve consecutive patients with their first middle cerebral artery (MCA) infarction were included. Lesion volumes were assessed on T2W images recorded with a turbo spin echo (TSE) and on images recorded with the FLAIR sequence on average on day 8 and after about four months. They were compared with acute lesion volumes in perfusion and DWI images taken within 24 hours of stroke onset. RESULTS: On day 8, lesion volumes in images obtained with FLAIR exceeded the acute infarct volumes in DWI. The chronic lesion volumes were almost identical in T2W and FLAIR images but significantly reduced compared with the acute DWI lesions. The lesion volumes assessed on DWI images correlated highly with the lesions in the images obtained with TSE or FLAIR, as did the lesions in the images obtained with FLAIR and TSE. The secondary lesion shrinkage was accompanied by ventricular enlargement and perilesional sulcal widening, as most clearly visible in the images obtained with FLAIR. CONCLUSION: Our results show that the acute DWI lesions are highly predictive for the infarct lesion in the chronic stage after stroke despite a dynamic lesion evolution most evident in MR images obtained with FLAIR.