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P31 Animal experiments indicated that the severity of the  apparent diffusion coefficient (ADC) decrease might serve as indicator  of tissue viability. We followed the temporal and spatial development  of ADC values after acute human stroke to test this hypothesis. Methods  We enrolled 10 consecutive patients with acute ischemic stroke during  the last 4 hours. Multimodal MRI (DWI, PWI, MRA, T2w) was performed  within 4 h after symptom onset and at days 1 and 7.  NIH-stroke-scale was assessed. The mean ADC value for the not affected  hemisphere served as reference for the relative ADC-reduction of  &lt;50%, 50–60%, 60–70% and 70–80%. Volume of these regions was  determined for each imaging timepoint using a threshold function. In a  second approach we transferred the previously obtained ADC-theshold  areas of day 0 to day 1 and 7 for detection of ADC-changes to determine  ADC-changes in reference to the initial ADC. Results In 4 patients with  clear neurological improvement at day 1 we found a mean reduction of  the ADC- lesion“-volume to 56%. The ADC-threshold-volume of 70–80%  increased by 38.9% and areas below 70% decreased by between 56.7%  (&lt;50% ADC) and 23.5% (60–70%). Some areas with severe ADC  decreases showed partial pseudo-normalization (lesion in T2w / normal  ADC values, n=3) and normalization (normal T2w / normal ADC values,  n=1) at day 1 and 7. Patients without change or a minor clinical  improvement showed a mean increase of the ADC-lesion size at day 1 by  83.6 %. In these patients volume with ADC&lt;50% increased by 275.7%  while 70–80%-threshold-volume decreased to 52.2%. ADC values within  the initial ADC-threshold-volumes differed significantly at day 1  (n=7), reflecting a different dynamics dependent on the initial ADC.  Conclusion Ischemic tissue with severe ADC decreases may recover  completely. However, areas with severe ADC decreases usually transform  towards a less severe decrease in patients with good neurological  recovery. In patients without clinical improvement the area of severe  diffusion impairment spreads to adjacent areas.

Severe ADC Decreases Do Not Predict Irreversible Tissue Damage In Acute Human Stroke