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Abstract #0142

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

Jonathan Rafael-Patiño1,2, Elda Fischi-Gomez1, Sebastian Otálora3, Veronica Ravano1,2,4, Guillaume Saliou1, Steven David Hajdu1, Tobias Kober1,2,4, 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


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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