{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:09:14Z","timestamp":1790406554101,"version":"4.1.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background and Purpose\u2014<\/jats:italic>\n            <\/jats:bold>\n            We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods\u2014<\/jats:italic>\n            <\/jats:bold>\n            Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient &lt;80% (ADC\n            <jats:sub>&lt;80%<\/jats:sub>\n            ) and time to peak &gt;+4 seconds (TTP\n            <jats:sub>&gt;+4s<\/jats:sub>\n            ) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADC\n            <jats:sub>core<\/jats:sub>\n            ) and relative ADC within the ADC\n            <jats:sub>&lt;80%<\/jats:sub>\n            lesion (rADC\n            <jats:sub>lesion<\/jats:sub>\n            ) were measured. Neurological deficit at admission was assessed with the National Institutes of Health Stroke Scale (NIHSS).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            Patients with MMI showed larger ADC\n            <jats:sub>&lt;80%<\/jats:sub>\n            (median, 157 versus 22 mL;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001) and TTP\n            <jats:sub>&gt;+4s<\/jats:sub>\n            (208 versus 125 mL;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001) lesion volumes, smaller TTP\/ADC mismatch ratio (1.5 versus 5.5;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), lower ADC\n            <jats:sub>core<\/jats:sub>\n            values (290 versus 411 mm\n            <jats:sup>2<\/jats:sup>\n            \/s;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), lower rADC\n            <jats:sub>lesion<\/jats:sub>\n            (0.60 versus 0.66;\n            <jats:italic>P<\/jats:italic>\n            =0.001), higher frequency of carotid-T occlusion (64% versus 15%;\n            <jats:italic>P<\/jats:italic>\n            =0.006), and higher NIHSS score at admission (20 versus 15;\n            <jats:italic>P<\/jats:italic>\n            =0.001). Predictors of MMI were as follows for sensitivity and specificity, respectively: ADC\n            <jats:sub>&lt;80%<\/jats:sub>\n            &gt;82 mL, 87%, 91%; TTP\n            <jats:sub>&gt;+4s<\/jats:sub>\n            &gt;162 mL, 83%, 75%; TTP\/ADC mismatch ratio &lt;2.4, 80%, 79%; ADC\n            <jats:sub>core<\/jats:sub>\n            &lt;300 mm\n            <jats:sup>2<\/jats:sup>\n            \/s, 83%, 85%; rADC\n            <jats:sub>lesion<\/jats:sub>\n            &lt;0.62, 79%, 74%; and NIHSS score at admission \u226519, 96%, 72%.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.\n          <\/jats:p>","DOI":"10.1161\/01.str.0000081985.44625.b6","type":"journal-article","created":{"date-parts":[[2003,7,15]],"date-time":"2003-07-15T00:21:20Z","timestamp":1058228480000},"page":"1892-1899","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":163,"title":["Prediction of Malignant Middle Cerebral Artery Infarction by Early Perfusion- and Diffusion-Weighted Magnetic Resonance Imaging"],"prefix":"10.1161","volume":"34","author":[{"given":"Go\u0308tz J.","family":"Thomalla","sequence":"first","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kucinski","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Schoder","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Knab","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herrmann","family":"Zeumer","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Weiller","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); and Institut fu\u0308r Mathematik und Datenverarbeitung in der Medizin (V.S.), Universita\u0308tsklinikum Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Ro\u0308ther","sequence":"additional","affiliation":[{"name":"From the Klinik und Poliklinik fu\u0308r Neurologie (G.J.T., R.K., C.W., J.R.); Neuroradiologische Abteilung, Klinik und Poliklinik fu\u0308r Radiologie (T.K., J.F., H.Z.); 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