Using longitudinal metamorphosis to examine ischemic stroke lesion dynamics on perfusion-weighted images and in relation to final outcome on T2-w images

We extend the image-to-image metamorphosis into constrained longitudinal metamorphosis. We apply it to estimate an evolution scenario, in patients with acute ischemic stroke, of both scattered and solitary ischemic lesions visible on serial MR perfusion weighted imaging from acute to subacute stages. We then estimate a patient-specific residual map that enables us to capture the most relevant shape and intensity changes, continuously, as the lesion evolves from acute through subacute to chronic timepoints until merging into the final image. We detect areas with high residuals (i.e., high dynamics) and identify areas that became part of the final T2-w lesion obtained at ≥ 1 month after stroke. This allows the investigation of the dynamic influence of perfusion values on the final lesion outcome as seen on T2-w imaging. The model provides detailed insights into stroke lesion dynamic evolution in space and time that will help identify factors that determine final outcome and identify targets for interventions to improve outcome.