Abstract #0142

Acute Ischemic Stroke: Infarct Core Estimation from Threshold-based DWI Delineation Depends on the DWI protocol

Jonathan Rafael-Patiño^1,2, Elda Fischi-Gomez¹, Sebastian Otálora³, Veronica Ravano^1,2,4, Guillaume Saliou¹, Steven David Hajdu¹, Tobias Kober^1,2,4, Roland Wiest³, Patrik Michel⁵, Richard McKinley³, and Jonas Richiardi¹

¹Radiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne., Lausanne, Switzerland, ²LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland, ³Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital., Bern, Switzerland, ⁴Advanced Clinical Imaging Technology, Siemens Healthcare AG., Lausanne, Switzerland, ⁵Stoke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

Synopsis

In acute stroke assessment, reference clinical trials such as DEFUSE-3 use absolute thresholds on ADC maps to define the infarct core. Yet, the variance of ADC values, but not the mean, change with the number of diffusion directions and the specific directions in a 4-directions sampling scheme. The resulting shifts in ADC distribution tails result in an overestimation of the infarct core. This has implications for multi-centric trials, where infarct sizes and locations may be biased simply due to diffusion protocol differences and/or different head positions with respect to B₀.

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