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Objectives <p>Diffusion-weighted imaging lesion reversal (DWI-R) is commonly observed on MRI after treatment for acute ischemic stroke. However, its extent across different brain regions post-endovascular therapy (EVT) and its long-term tissue-specific consequences are inadequately described in the literature. This study evaluated DWI-R across brain regions and tissue types and assessed long-term changes after 1 month.</p> Materials and methods <p>This cohort study included acute ischemic stroke patients with MRI acquired before and 12 to 36 h after EVT. DWI lesions were segmented and co-registered to MNI space to generate probabilistic maps of DWI-R distribution. The probability of DWI-R was analyzed in relation to the involvement of white matter, cortical regions, and deep gray matter. Changes indicative of tissue damage were evaluated in a subgroup with follow-up imaging &gt; 1 month post-EVT.</p> Results <p>Of 565 consecutive EVT patients in the period January 2017-March 2022, 303 were included. DWI-R was observed in all major vascular territories. White matter showed 1.95 times higher probability of DWI-R compared to deep gray matter (<i>p</i> &lt; 0.001), with no significant difference compared to cortical regions. Among 62 DWI-R cases with follow-up imaging, 29 (47%) showed no signal changes in areas of the initial lesion, with no significant difference between white and gray matter.</p> Conclusions <p>Caution is advised when excluding patients from EVT based on restrictive diffusion, as both white and gray matter frequently responded to treatment in this study.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Understanding diffusion-weighted imaging reversal following endovascular therapy is crucial for stroke diagnostics, yet its regional distribution and long-term tissue-specific consequences remain poorly characterized</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Diffusion-weighted imaging reversal occurred throughout the brain, often persisted, and did not significantly differ between white matter and cortical regions</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Restrictive diffusion on MRI should be used with caution to exclude acute ischemic stroke patients from endovascular therapy, as such changes often respond to treatment both in white and gray matter</i>.</p> Graphical Abstract <p></p>

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Mapping DWI signal reversal and long-term tissue outcomes following endovascular therapy in acute ischemic stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月1日

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  • Thor Håkon Skattør,
  • Cecilie Mørck Offersen,
  • Terje Nome,
  • Kine Mari Bakke,
  • Brian Anthony B. Enriquez,
  • Jonathan Frederik Carlsen,
  • Mona Kristiansen Beyer,
  • Atle Bjørnerud,
  • Anne Hege Aamodt

摘要

Objectives

Diffusion-weighted imaging lesion reversal (DWI-R) is commonly observed on MRI after treatment for acute ischemic stroke. However, its extent across different brain regions post-endovascular therapy (EVT) and its long-term tissue-specific consequences are inadequately described in the literature. This study evaluated DWI-R across brain regions and tissue types and assessed long-term changes after 1 month.

Materials and methods

This cohort study included acute ischemic stroke patients with MRI acquired before and 12 to 36 h after EVT. DWI lesions were segmented and co-registered to MNI space to generate probabilistic maps of DWI-R distribution. The probability of DWI-R was analyzed in relation to the involvement of white matter, cortical regions, and deep gray matter. Changes indicative of tissue damage were evaluated in a subgroup with follow-up imaging > 1 month post-EVT.

Results

Of 565 consecutive EVT patients in the period January 2017-March 2022, 303 were included. DWI-R was observed in all major vascular territories. White matter showed 1.95 times higher probability of DWI-R compared to deep gray matter (p < 0.001), with no significant difference compared to cortical regions. Among 62 DWI-R cases with follow-up imaging, 29 (47%) showed no signal changes in areas of the initial lesion, with no significant difference between white and gray matter.

Conclusions

Caution is advised when excluding patients from EVT based on restrictive diffusion, as both white and gray matter frequently responded to treatment in this study.

Key Points

Question Understanding diffusion-weighted imaging reversal following endovascular therapy is crucial for stroke diagnostics, yet its regional distribution and long-term tissue-specific consequences remain poorly characterized.

Findings Diffusion-weighted imaging reversal occurred throughout the brain, often persisted, and did not significantly differ between white matter and cortical regions.

Clinical relevance Restrictive diffusion on MRI should be used with caution to exclude acute ischemic stroke patients from endovascular therapy, as such changes often respond to treatment both in white and gray matter.

Graphical Abstract