Comparison of the infarct volumes measured with cavalieri principle and classical method in patients with acute ischemic stroke

Introduction and Objectives: Cerebral ischemia is a clinical condition which occurs when blood flow in a specific area of brain drops below the level needed for maintanence of normal cerebral fuctions, and is diagnosed using clinical features and imaging findings. Several volume measurement methods are used in radiological imaging; the most common one is Clasical Method which depends on measurement of the volume using a formula. In this study, the volume measured using the Cavalieri principle which is mostly used in experimental studies and has less clinical use is compared with the one measured with the Classical method. Materials and Methods: A total of 44 patients above 18 years of age who were admitted to Düzce University Hospital Emergency Department and diagnosed with acute ischemic stroke after having diffusion-weighted MRI were included in the study. This study was designed as a prospective case study. Continuous and gapless diffusion-weighted MRI in T2 sequence was performed with HITACHI Echelon 1.5 Tesla MRI device. Infarct volumes measured with the Classical Method and the Cavalieri Priciple were compared. Besides, the relationship between the clinical condition of the patient and the size of infact volume was evaluated. Results: The mean infarct volume calculated with the Classical Method (1.06 ± 1.40 cm³) was significantly higher than the one measured with the Cavalleri Principle (.97 ± 1.33 cm³) in conscious patients (p <.001). The mean infarct volume calculated with the Classical Method (right: 2.50 ± 3,98 cm³; left: 1.61 ± 2.35 cm³) was found to be significantly higher than that measured using the Cavalieri Principle (right: 2.41 ± 4.08 cm³; left: 1.51 ± 2.24 cm³) in patients with both right-sided and left-sided muscle v weakness (p <.005). There was a weak correlation between age and infarct volume measured with the Classical Method in patients with right-sided hemiplegia (r:.406). A strong negative correlation between GCS score and NIHS score was found in all patients (r:-.705). Infarct volume measured with the Cavalieri Principle was found to be lower than the one calculated with the Classical Method. Mean infarct volume of the unconscious patients and lethargic patients were found to be higher than that of the conscious patients. Infarct volume of the elderly patients (80 years of age or older) was higher than that of younger patients. Conclusion: The Cavalieri method has been found to give more optimistic results for patients. Cadaver studies, animal experiments or long-term clinical trials are needed to determine which of these methods make more accurate measurements. Keywords: Cavalieri Method, Classical Method, Infarct, Brain, Stroke