Hemodynamic Parameter Assessment With Dynamic Susceptibility Contrast Magnetic Resonance Imaging in Unilateral Symptomatic Internal Carotid Artery Occlusion

Nighoghossian, Norbert; Berthezène, Yves; Philippon, B.; Adeleine, P.; Froment, J; Trouillas, P

doi:10.1161/01.str.27.3.474

Cited by 36 publications

(26 citation statements)

References 25 publications

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“…For ease of comparison, we used the box, triangular, and exponential models of R(t), depending on the vascular models, in the same way others have reported: [3][4][5] a) box model:…”

Section: Modelmentioning

confidence: 99%

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Reference-based Maximum Upslope: A CBF Quantification Method without Using Arterial Input Function in Dynamic Susceptibility Contrast MRI

Kimura

Kusahara

2009

magn reson med sci

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Purpose: We assessed errors in cerebral blood ‰ow (CBF) obtained from our proposed reference-based method without using arterial input function (AIF) indices in dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI).Materials and Methods: We calculated CBF and the referential tissue-related ratio (CBFratio) using numerical simulation and 3 nondeconvolution methods and a deconvolution method of block-circulant singular value decomposition (cSVD). We compared errors with and without simulated noise as parameters of mean transit time (MTT), AIF delay and temporal resolution, and clinical DSC-MRI maps.Results: The errors in CBF obtained using maximum upslope (US) were smallest among the nondeconvolution methods and almost equivalent to errors in the cSVD method under practical imaging conditions. In addition, errors in the CBFratio obtained using referencebased US (Ref-US) referring to white matter were smallest, even compared to all errors in CBF and CBFratio. The Ref-US method introduced less error than the cSVD method, especially at low ‰ow rates, was further robust against AIF noise and coarse temporal resolution, and was comparably robust against transit delay. In pixel-by-pixel correlations between absolute value maps for US and for cSVD-CBF in clinical DSC-MRI, those correlation coe‹cients (r) between the 2 maps were stable, rÀ0.9, despite variation in the slopes of the linear regression line, so the 2 CBFratio maps were visually well correlated in any case.Conclusion: The Ref-US technique without AIF measurement can become a practical perfusion methodology for DSC-MRI in patients even with acute stroke because it balances robustness with systematic and random errors and it is simply performed.

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“…For ease of comparison, we used the box, triangular, and exponential models of R(t), depending on the vascular models, in the same way others have reported: [3][4][5] a) box model:…”

Section: Modelmentioning

confidence: 99%

“…4,5 After the C(t) isˆtted in the volume of interest (VOI), with or without the gamma variate function, several parameters that re‰ect tissue perfusion ( Fig. 1) are calculated and used as indices of relative perfusion.…”

Section: Introductionmentioning

confidence: 99%

Reference-based Maximum Upslope: A CBF Quantification Method without Using Arterial Input Function in Dynamic Susceptibility Contrast MRI

Kimura

Kusahara

2009

magn reson med sci

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“…This is a commonly used method (see for example Refs. [3][4][5][6][7][8][9][10] because the analysis of data is fast and straightforward, and does not necessarily require measurement of the AIF. However, summary parameters can only provide indirect measures of perfusion, although they are frequently quoted as approximations to physiological variables despite early studies indicating that this is not the case (11).…”

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confidence: 99%

Is quantification of bolus tracking MRI reliable without deconvolution?

Perthen

Calamante

Gadian

et al. 2001

Magnetic Resonance in Med

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Bolus tracking data obtained with paramagnetic intravascular tracers are commonly analyzed and quantified by the direct measurement of properties of the tissue concentration-time curve (e.g., time to peak (TTP)). The measurement of these "summary parameters" is used as an accessible alternative approach to the complex deconvolution procedure, and provides indirect measures of perfusion. However, summary parameters do not take into account differences in arterial input functions (AIFs) or residue functions (R(t)) between patients or studies. Simulations were performed to assess the variability of summary parameters over a realistic range of AIFs and for differing R(t), to establish whether they can be used as reliable measures of tissue perfusion status. Results showed that the value of each summary parameter investigated is highly dependent upon both the AIF and R(t). The referencing of summary parameters to their corresponding value in the AIF or in normal tissue is a method commonly used to normalize results, but this approach did not lead to any measures that were independent of both the AIF and R(t) in this study. The results presented here show that the use of summary parameters requires considerable caution, since tissue or patient types can easily be incorrectly classified due to the effect of variations in patient AIF and R(t). Dynamic susceptibility contrast (DSC) MRI is increasingly used for the measurement of cerebral perfusion (1). This method requires the injection of a bolus of a paramagnetic intravascular contrast agent, and the rapid measurement of the MR signal loss caused by the passage of the bolus through the tissue. This signal loss can be converted to a concentration-time curve of contrast agent within the tissue, C(t). Using principles of indicator dilution theory, C(t) within a region of interest (ROI) can be expressed as a convolution (1,2):where C a (t) is the arterial input function (AIF), i.e., the concentration of tracer entering the ROI, and R(t) is the residue function, which describes the fraction of contrast agent remaining in the ROI at time t, following the injection of an ideal bolus at t ϭ 0. CBF is cerebral blood flow, is the density of brain tissue, and k H accounts for the difference in hematocrit between capillaries and large vessels. There are two commonly used approaches to the analysis and quantification of DSC data. The first requires measurement of the AIF in order to perform the deconvolution of C(t) using Eq. [1] (2). This method can produce direct information about the physiological parameters CBF, cerebral blood volume (CBV), and mean transit time (MTT), but involves very time-consuming postprocessing. The second approach uses summary parameters calculated directly from the profile of the C(t) curve (e.g., time to peak (TTP), maximum peak concentration (MPC), etc.). This is a commonly used method (see for example Refs. 3-10) because the analysis of data is fast and straightforward, and does not necessarily require measurement of the AIF. However, summary paramete...

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“…It is now well established that impaired hemodynamics can be demonstrated with PWI in patients with hemodynamically relevant ICA disease (without prior stroke). [15][16][17][18][19] However, previous studies have not addressed the question whether DWI and PWI findings differ between acute stroke patients with and without severe carotid disease and whether this relates to differences in stroke evolution.…”

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confidence: 99%

Diffusion- and Perfusion-Weighted MRI

Neumann‐Haefelin

Wittsack

Fink

et al. 2000

Stroke

123

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Background and Purpose-Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) have been used increasingly in recent years to evaluate acute stroke in the emergency setting. In the present study, we compared DWI and PWI findings in acute stroke patients with and without severe extracranial internal carotid artery (ICA) disease. Methods-Twenty-seven patients with nonlacunar ischemic stroke were selected for this analysis. DWI, PWI, and conventional MRI were performed in all patients within 24 hours of symptom onset and after 1 week. To exclude patients with partial or complete reperfusion, we included only patients with a PWI deficit larger than the DWI lesion. Severe ICA disease (Ͼ70% stenosis) was present unilaterally in 9 and bilaterally in 2 patients. Acute DWI lesion volume, the size of the acute PWI/DWI mismatch, and final infarct size (on T2-weighted images) were determined. Results-The PWI/DWI mismatch was significantly larger in patients with severe ICA disease than in patients without extracranial carotid stenosis, both when time-to-peak and mean transit time maps (PϽ0.01) were used to calculate the mismatch. Quantitative analysis of the time-to-peak delay in the mismatch indicated that a relatively smaller fraction of the total mismatch was critically ischemic in patients with carotid stenosis than in those without. Average lesion volume increased less in the stenosis group (Pϭ0.14), despite the larger PWI/DWI mismatch, and final infarct size was smaller in the stenosis group (PϽ0.05). In the 2 patients with bilateral ICA disease, variable hemodynamic involvement of the contralateral hemisphere was found in addition to the ipsilateral PWI deficit. Conclusions-In most acute stroke patients with severe ICA stenosis, a considerably smaller fraction of the total PWI/DWI mismatch is at risk than in patients without carotid disease.

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Hemodynamic Parameter Assessment With Dynamic Susceptibility Contrast Magnetic Resonance Imaging in Unilateral Symptomatic Internal Carotid Artery Occlusion

Abstract: A significant hemodynamic compromise in patients who had unilateral symptomatic carotid occlusion was observed according to CBF and MTT values. This approach might be promising in the understanding of cerebral hemodynamics in patients with vascular disorders.

Cited by 36 publications

References 25 publications

Reference-based Maximum Upslope: A CBF Quantification Method without Using Arterial Input Function in Dynamic Susceptibility Contrast MRI

Reference-based Maximum Upslope: A CBF Quantification Method without Using Arterial Input Function in Dynamic Susceptibility Contrast MRI

Is quantification of bolus tracking MRI reliable without deconvolution?

Diffusion- and Perfusion-Weighted MRI

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