Top

Published in:

01-08-2011 | Diagnostic Neuroradiology

Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI

Authors: Thomas Ritzenthaler, Tae-Hee Cho, Marlène Wiart, Julien Berthiller, Leif Østergaard, Marc Hermier, Laurent Derex, Yves Berthezène, Norbert Nighoghossian

Published in: Neuroradiology | Issue 8/2011

Abstract

Introduction

The value of perfusion MRI for identifying the tissue at risk has been questioned. Our objective was to assess baseline perfusion-weighted imaging parameters within infarct progression areas.

Methods

Patients with anterior circulation stroke without early reperfusion were included from a prospective MRI database. Sequential MRI examinations were performed on admission, 2–3 h (H2), 2–3 days (D2), and between 15 and 30 days after the initial MRI. Maps of baseline time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were calculated. Lesion extension areas were defined as pixels showing de novo lesions between each MRI and were generated by subtracting successive lesion masks: V₀, baseline diffusion-weighted imaging (DWI) lesion; V₁, lesion extension between baseline and H2 DWI; V₂, lesion extension from H2 to D2 DWI; and V₃, lesion extension from D2 DWI to final FLAIR. Repeated measures analysis was used to compare hemodynamic parameters within the baseline diffusion lesion and subsequent lesion extension areas.

Results

Thirty-two patients were included. Baseline perfusion parameters were significantly more impaired within the acute DWI lesion compared to lesion extension areas (TTP, p < 0.0001; MTT, p < 0.0001; CBF p < 0.0001; CBV, p < 0.0001). A significant decrease in MTT (p = 0.01) and TTP (p = 0.01) was found within successive lesion growth areas.

Conclusion

A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas.

Warach S, Dashe JF, Edelman RR (1996) Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab 16:53–59PubMedCrossRef

Baird AE, Benfield A, Schlaug G, Siewert B, Lövblad KO, Edelman RR, Warach S (1997) Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 41:581–589PubMedCrossRef

Kloska SP, Wintermark M, Engelhorn T, Fiebach JB (2010) Acute stroke magnetic resonance imaging: current status and future perspective. Neuroradiology 52:189–201PubMedCrossRef

Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, Bammer R, Kakuda W, Lansberg MG, Shuaib A, Coplin W, Hamilton S, Moseley M, Marks MP, DEFUSE Investigators (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 60:508–517PubMedCrossRef

Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, Barber PA, Bladin C, De Silva DA, Byrnes G, Chalk JB, Fink JN, Kimber TE, Schultz D, Hand PJ, Frayne J, Hankey G, Muir K, Gerraty R, Tress BM, Desmond PM (2008) Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Lancet Neurol 7:299–309PubMedCrossRef

Carroll TJ, Teneggi V, Jobin M, Squassante L, Treyer V, Hany TF, Burger C, Wang L, Bye A, Von Schulthess GK, Buck A (2002) Absolute quantification of cerebral blood flow with magnetic resonance, reproducibility of the method, and comparison with H2(15)O positron emission tomography. J Cereb Blood Flow Metab 22:1149–1156PubMedCrossRef

Heiss WD, Sobesky J, Hesselmann V (2004) Identifying thresholds for penumbra and irreversible tissue damage. Stroke 35:2671–2674PubMedCrossRef

Rivers CS, Wardlaw JM, Armitage PA, Bastin ME, Carpenter TK, Cvoro V, Hand PJ, Dennis MS (2006) Do acute diffusion- and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke? Stroke 37:98–104PubMedCrossRef

Mezzapesa DM, Petruzzellis M, Lucivero V, Prontera M, Tinelli A, Sancilio M, Carella A, Federico F (2006) Multimodal MR examination in acute ischemic stroke. Neuroradiology 48:238–246PubMedCrossRef

10.

Coutts SB, Simon JE, Tomanek AI, Barber PA, Chan J, Hudon ME, Mitchell JR, Frayne R, Eliasziw M, Buchan AM, Demchuk AM (2003) Reliability of assessing percentage of diffusion–perfusion mismatch. Stroke 34:1681–1683PubMedCrossRef

11.

Mishra NK, Albers GW, Davis SM, Donnan GA, Furlan AJ, Hacke W, Lees KR (2010) Mismatch-based delayed thrombolysis: a meta-analysis. Stroke 41:e25–e33PubMedCrossRef

12.

Neumann-Haefelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz RJ, Mödder U, Freund HJ (1999) Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke 30:1591–1597PubMedCrossRef

13.

Sobesky J, Zaro Weber O, Lehnhardt FG, Hesselmann V, Thiel A, Dohmen C, Jacobs A, Neveling M, Heiss WD (2004) Which time-to-peak threshold best identifies penumbral flow? A comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke 35:2843–2847PubMedCrossRef

14.

Sobesky J, Zaro Weber O, Lehnhardt FG, Hesselmann V, Neveling M, Jacobs A, Heiss WD (2005) Does the mismatch match the penumbra? Magnetic resonance imaging and positron emission tomography in early ischemic stroke. Stroke 36:980–985PubMedCrossRef

15.

Kidwell CS, Alger JR, Saver JL (2003) Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke 34:2729–2735PubMedCrossRef

16.

Olivot JM, Mlynash M, Thijs VN, Purushotham A, Kemp S, Lansberg MG, Wechsler L, Bammer R, Marks MP, Albers GW (2009) Relationships between cerebral perfusion and reversibility of acute diffusion lesions in DEFUSE: insights from RADAR. Stroke 40:1692–1697PubMedCrossRef

17.

Guadagno JV, Warburton EA, Jones PS, Fryer TD, Day DJ, Gillard JH, Carpenter TA, Aigbirhio FI, Price CJ, Baron JC (2005) The diffusion-weighted lesion in acute stroke: heterogeneous patterns of flow/metabolism uncoupling as assessed by quantitative positron emission tomography. Cerebrovasc Dis 19:239–246PubMedCrossRef

18.

Guadagno JV, Warburton EA, Jones PS, Day DJ, Aigbirhio FI, Fryer TD, Harding S, Price CJ, Green HA, Barret O, Gillard JH, Baron JC (2006) How affected is oxygen metabolism in DWI lesions? A combined acute stroke PET–MR study. Neurology 67:824–829PubMedCrossRef

19.

Olivot JM, Mlynash M, Thijs VN, Purushotham A, Kemp S, Lansberg MG, Wechsler L, Gold GE, Bammer R, Marks MP, Albers GW (2009) Geography, structure, and evolution of diffusion and perfusion lesions in Diffusion and perfusion imaging Evaluation For Understanding Stroke Evolution (DEFUSE). Stroke 40:3245–3251PubMedCrossRef

20.

Nuutinen J, Liu Y, Laakso MP, Karonen JO, Vanninen EJ, Kuikka JT, Aronen HJ, Vanninen RL (2009) Perfusion differences on SPECT and PWI in patients with acute ischemic stroke. Neuroradiology 51:687–695PubMedCrossRef

21.

Eckert B, Küsel T, Leppien A, Michels P, Müller-Jensen A, Fiehler J (2010) Clinical outcome and imaging follow-up in acute stroke patients with normal perfusion CT and normal CT angiography. Neuroradiology Apr 27. doi:10.1007/s00234-010-0702-9

22.

Christensen S, Mouridsen K, Wu O, Hjort N, Karstoft H, Thomalla G, Röther J, Fiehler J, Kucinski T, Østergaard L (2009) Comparison of 10 perfusion MRI parameters in 97 sub-6-hour stroke patients using voxel-based receiver operating characteristics analysis. Stroke 40:2055–2061PubMedCrossRef

23.

Kane I, Carpenter T, Chappell F, Rivers C, Armitage P, Sandercock P, Wardlaw J (2007) Comparison of 10 different magnetic resonance perfusion imaging processing methods in acute ischemic stroke: effect on lesion size, proportion of patients with diffusion/perfusion mismatch, clinical scores, and radiologic outcomes. Stroke 38:3158–3164PubMedCrossRef

24.

Schlaug G, Benfield A, Baird AE, Siewert B, Lövblad KO, Parker RA, Edelman RR, Warach S (1999) The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 53:1528–1537PubMed

25.

Grandin CB, Duprez TP, Smith AM, Mataigne F, Peeters A, Oppenheim C, Cosnard G (2001) Usefulness of magnetic resonance-derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke 32:1147–1153PubMedCrossRef

26.

Schaefer PW, Ozsunar Y, He J, Hamberg LM, Hunter GJ, Sorensen AG, Koroshetz WJ, Gonzalez RG (2003) Assessing tissue viability with MR diffusion and perfusion imaging. AJNR Am J Neuroradiol 24:436–443PubMed

27.

Kucinski T, Naumann D, Knab R, Schoder V, Wegener S, Fiehler J, Majumder A, Röther J, Zeumer H (2005) Tissue at risk is overestimated in perfusion-weighted imaging. AJNR Am J Neuroradiol 26:815–819PubMed

28.

Røhl L, Ostergaard L, Simonsen CZ, Vestergaard-Poulsen P, Andersen G, Sakoh M, Le Bihan D, Gyldensted C (2001) Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke 32:1140–1146PubMedCrossRef

29.

Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, Ojemann RG (1981) Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54:773–782PubMedCrossRef

30.

Zivin JA (1998) Factors determining the therapeutic window for stroke. Neurology 50:599–603PubMed

Title: Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI
Authors: Thomas Ritzenthaler
Tae-Hee Cho
Marlène Wiart
Julien Berthiller
Leif Østergaard
Marc Hermier
Laurent Derex
Yves Berthezène
Norbert Nighoghossian
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 8/2011
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-010-0793-3

At a glance: The STEP trials

Springer Medicine

Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2011

The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI

Mammillotegmental tract in the human brain: diffusion tensor tractography study

The Woven EndoBridge Cerebral Aneurysm Embolization Device (WEB II): initial clinical experience

European Society of Neuroradiology (ESNR)

Osborn AG, Ross, Crim J, Salzman K, Blaser S: Expert differential diagnoses: brain and spine

Quantification of recurrence volumes after endovascular treatment of cerebral aneurysm as surrogate endpoint for treatment stability