This study analyses the dynamic changes in infarction volume captured by Diffusion-Weighted Imaging (DWI) during acute stroke admission and explores the associations between these changes and various patient characteristics.
We evaluated data from a prospective stroke registry spanning 2005 to 2022, involving patients who underwent multiple DWIs during hospitalisation. DWI lesion volumes were automatically quantified using JBS-DWI software. A multivariable quantile regression model was applied, incorporating variables such as age, medical history, smoking status, endovascular thrombectomy (EVT), initial glucose levels, blood pressure, lesion volume, stroke aetiology, and DWI timing, to assess their impact on DWI lesion volume changes.
The study included 7,125 patients (61% male, mean age 68 ± 13.5 years) with a median initial NIHSS of 3 (IQR 1–7). Intravenous thrombolysis and EVT were administered in 10.3% and 13.2% of cases, respectively. The median interval between initial and follow-up DWIs was 86 hours (IQR 66.0–105.1). Median initial and follow-up lesion volumes were 0.85 ml (IQR 0.23–4.52) and 1.73 ml (IQR 0.50–8.56), respectively. EVT and cardioembolic stroke aetiology were positively associated with volume changes, while age, initial lesion volume, and time from last seen well to imaging showed negative associations. The impact of age and EVT varied across quantiles of volume changes.
Age and time metrics correlate with decreased lesion volumes, whereas EVT and cardioembolism are associated with increased volumes, demonstrating the multifactorial dynamics of stroke progression.