Improved prediction of final infarct volume using bolus delay-corrected perfusion-weighted MRI: Implications for the ischemic penumbra

Rose, Stephen E., Janke, Andrew L., Griffin, Mark, Finnigan, Simon and Chalk, Jonathan B. (2004) Improved prediction of final infarct volume using bolus delay-corrected perfusion-weighted MRI: Implications for the ischemic penumbra. Stroke, 35 11: 2466-2471. doi:10.1161/01.STR.0000145199.64907.5a


Author Rose, Stephen E.
Janke, Andrew L.
Griffin, Mark
Finnigan, Simon
Chalk, Jonathan B.
Title Improved prediction of final infarct volume using bolus delay-corrected perfusion-weighted MRI: Implications for the ischemic penumbra
Journal name Stroke   Check publisher's open access policy
ISSN 0039-2499
Publication date 2004-11-01
Sub-type Article (original research)
DOI 10.1161/01.STR.0000145199.64907.5a
Volume 35
Issue 11
Start page 2466
End page 2471
Total pages 6
Place of publication Hagerstown, U.S.
Publisher The American Heart Association
Language eng
Subject 1117 Public Health and Health Services
Formatted abstract
Background and Purpose - Magnetic resonance imaging (MRI)-based perfusion measures using dynamic susceptibility contrast are extremely useful for identification of ischemic penumbral tissue in acute stroke. However, errors in the measurement of cerebral blood flow (CBF)and mean transit time (MTT) can occur. The aim of this study was to investigate whether bolus delay-corrected (BDC) perfusion measures enable better delineation of the ischemic penumbra.

Methods - Diffusion-weighted MRI (DWI) and perfusion-weighted MRI data were acquired from 19 acute stroke patients. Perfusion abnormalities were manually defined on BDC perfusion maps (corrected MTT [cMTT] and corrected CBF [cCBF]), and on maps derived from an arterial input function placed within the contralateral (CBF, MTT) and ipsilateral (ipsilateral CBF [iCBF] and ipsilateral MTT [iMTT]) middle cerebral artery. Perfusion lesion volumes were correlated with 30-day T2-weighted MRI lesion volumes and with clinical outcome using the National Institutes of Health Stroke Scale (NIHSS).

Results -
Spearman correlation coefficients for comparing lesion volumes delineated on DWI, CBF, iCBF, cCBF, MTT, iMTT, and cMTT maps with 30-day T2-weighted lesion volumes were 0.72, 0.87, 0.88, 0.90, 0.84, 0.92, and 0.96, respectively (all P<0.001). The analogous correlation coefficients for comparing 30-day National Institutes of Health Stroke Scale (NIHSS) scores were 0.39 (NS), 0.69 (NS), 0.75 (P<0.001), 0.62 (NS), 0.72 (P<0.001), 0.78 (P<0.001), and 0.83 (P<0.001), respectively.

Conclusions - Uncorrected perfusion lesion volumes overestimated the extent of ischemic injury. BDC perfusion measures (cMTT) correlated more accurately with final lesion volume and clinical outcome. Such measures offer an improved estimation of the final infarct size in acute stroke.
Keyword Clinical Neurology
Peripheral Vascular Disease
Cerebral Ischemia
Magnetic Resonance Imaging, Diffusion-weighted
Magnetic Resonance Imaging, Perfusion-weighted
Stroke, Acute
Diffusion
Flow
Mismatch
Stroke
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
Centre for Advanced Imaging Publications
 
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Created: Tue, 14 Aug 2007, 00:42:27 EST