Diffusion-weighted MR Imaging of the Brain: Correlation of Ischemic Lesion Patterns with ASCO Stroke Subtypes

Background: There are many etiologies for ischemic cerebral stroke. Previous studies have not shown whether specific ischemic lesion patterns on early brain diffusion-weighted imaging (DWI) are associated with specific ischemic stroke causes.

Objective: This study was designed to correlate the pattern and distribution of ischemic lesions on (DWI) with ASCO stroke subtypes [atherosclerosis (A), small vessel disease (S), cardiac source (C), and other cause (O)].

Subjects and Methods: We retrospectively evaluated patients with ischemic lesions within 72 hours of stroke onset who underwent brain DWI. Ischemic lesions were classified as single, scattered and multiple. The stroke subtypes were classified according to ASCO criteria.

Results: A total of 490 patients was studied, (285 Males, 205 females) with a mean age of 69.8± 10.4 years. We found (A) (N=180), (S) (N=70), (C) (N=145) and (O) (N=95). In patients with (A) the scattered anterior circulation lesions were statistically significant (45 patients, P=0.04). With (S) the most common and only pattern was to single subcortical lesion (70 patients, P=0.000). While, with (C), the statistical significance was to single cortical, multiple unilateral anterior circulation, single subcortical, and scattered anterior circulation respectively (65, 45, 15 and 15 patients, P=0.01, 0.02, 0.03, and 0.03). Patients with (O) were highly statistically significantly associated with single subcortical lesions (40 patients, P=0.000).

Conclusion: There is a significant correlation between the ASCO stroke subtypes and DWI patterns which assisted in determining the stroke etiology.