Neuroradiology (2006) 48: 632–639 DOI 10.1007/s00234-006-0105-0 DIAGNOSTIC NEURORADIOLOGY Daniel Šaňák Vladimír Nosál′ David Horák Andrea Bártková Kamil Zeleňák Roman Herzig Jiří Bučil David Školoudík Stanislav Buřval Viera Cisariková Ivanka Vlachová Martin Köcher Jana Zapletalová Egon Kurča Petr Kaňovský Received: 20 January 2006 Accepted: 2 May 2006 Published online: 29 August 2006 # Springer-Verlag 2006 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 Abstract Introduction: Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from throm- bolytic 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) (M 1–2 segment) occlusion detected on MRI angiography treated by intravenous/ intraarterial thrombolysis. Methods: Initial infarct volume (V DWI-I ) was retrospectively compared with neuro- logical 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 relation- ship between infarct volume and neurological deficit severity was as- sessed and, following the establish- ment of the maximum V DWI-I still associated with a good clinical out- come, the patients were divided into two groups (V DWI-I ≤70 ml and >70 ml). Results: V DWI-I ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a V DWI-I ≤70 ml (group 1) and dete- riorated significantly (P=0.0018) in all patients with a V DWI-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). Conclusion: Clinical outcome could be predicted from initial infarct volume quanti- fied by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial throm- bolysis. Patients with a V DWI-I ≤70 ml had a significantly better outcome. Keywords Acute ischemic stroke . Middle cerebral artery occlusion . Diffusion-weighted sequences . Initial infarct volume . Thrombolysis 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. D. Šaňák (*) . A. Bártková . R. Herzig . D. Školoudík . I. Vlachová . P. Kaňovský Stroke Center, Department of Neurology, University Hospital, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic e-mail: daniel.sanak@centrum.cz Tel.: +420-588-443432 Fax: +420-588-442528 V. Nosál′ . E. Kurča Department of Neurology, University Hospital, Martin, Slovak Republic D. Horák . J. Bučil . S. Buřval . M. Köcher Stroke Center, Department of Radiology, University Hospital, Olomouc, Czech Republic K. Zeleňák . V. Cisariková Department of Radiology, University Hospital, Martin, Slovak Republic J. Zapletalová Department of Biometry and Statistics, Palacký University Medical School, Olomouc, Czech Republic