J Neuroimaging. 2025 Nov-Dec;35(6):e70114. doi: 10.1111/jon.70114.
ABSTRACT
BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) is the gold standard for assessing ischemic core in acute stroke but may overestimate irreversible injury due to its assumption of Gaussian diffusion. Diffusion kurtosis imaging (DKI), which accounts for non-Gaussian water diffusion, may provide more accurate tissue characterization. Most prior studies examined DWI and DKI within 24 h or up to 1 month after stroke, but very few have captured both an ultra-early (e.g., 3-h) postreperfusion and a subacute (24-72 h) imaging window in the same population. This study compared DWI and DKI for measuring ischemic core evolution after reperfusion.
METHODS: Fifty-two patients with anterior circulation large vessel occlusion stroke underwent endovascular thrombectomy and were imaged with both DWI and DKI at <3 h and again at 24-72 h postreperfusion in a prospective multicenter longitudinal cohort study. Lesion volumes for DWI and DKI were manually segmented to derive a mismatch between DWI and DKI, and reversal between the two time points. Diffusion metrics (apparent diffusion coefficient [ADC] and mean kurtosis [MK]) within regions of interest were also analyzed.
RESULTS: DKI lesion volumes were significantly smaller than DWI at both time points (DWI 11.1 mL vs. DKI 8.5 mL, p = 0.007 at 3 h, and DWI 27.9 mL vs. DKI 19.3 mL, p = 0.002 at 24-72 h), with both increasing significantly over time. DKI(+ve)-DWI(-ve) mismatch regions showed higher ADC and lower MK, indicating less severe injury. The percentage amount of lesion that reversed in relation to the entire infarct was similar for both modalities (DWI: 15.9%, DKI: 12.4%, p > 0.05).
CONCLUSION: DKI offers additional information to DWI for identifying irreversibly injured tissue in acute stroke, with smaller lesion volumes and further information on tissue microstructure that reversed. These findings suggest DKI may enhance ischemic core assessment and help guide treatment decisions after reperfusion therapy.
PMID:41416612 | DOI:10.1111/jon.70114