Hyperacute Stroke: Simultaneous Measurement of Relative Cerebral Blood Volume, Relative Cerebral Blood Flow, and Mean Tissue Transit Time

Sorensen, A. Gregory; Copen, William A.; Østergaard, Leif; Buonanno, Ferdinando S.; González, Ramón; Rordorf, Guy; Rosen, Bruce R.; Schwamm, Lee H; Weisskoff, Robert M.; Koroshetz, Walter J.

doi:10.1148/radiology.210.2.r99fe06519

Cited by 375 publications

(267 citation statements)

References 22 publications

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“…2,6,7 However, lack of standard postprocessing procedures and threshold values may compromise robust characterization of a 'perfusion-diffusion mismatch', 3,8 and volumetric analysis may obscure and oversimplify the complex and heterogeneous status of the affected tissue. 7,9,10 This mismatch area may therefore overestimate the actual tissue area at risk, 5,11,12 as well as exclude injured tissue that is potentially salvageable. 13 The complex relation between multiple pathophysiologic factors involved in stroke lesion progression may be better caught and described using multiparametric imaging-based statistical algorithms.…”

Section: Introductionmentioning

confidence: 99%

Early Identification of Potentially Salvageable Tissue with MRI-Based Predictive Algorithms after Experimental Ischemic Stroke

Bouts

Tiebosch

Toorn

et al. 2013

J Cereb Blood Flow Metab

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Individualized stroke treatment decisions can be improved by accurate identification of the extent of salvageable tissue. Magnetic resonance imaging (MRI)-based approaches, including measurement of a 'perfusion-diffusion mismatch' and calculation of infarction probability, allow assessment of tissue-at-risk; however, the ability to explicitly depict potentially salvageable tissue remains uncertain. In this study, five predictive algorithms (generalized linear model (GLM), generalized additive model, support vector machine, adaptive boosting, and random forest) were tested in their potency to depict acute cerebral ischemic tissue that can recover after reperfusion. Acute T 2 -, diffusion-, and perfusion-weighted MRI, and follow-up T 2 maps were collected from rats subjected to right-sided middle cerebral artery occlusion without subsequent reperfusion, for training of algorithms (Group I), and with spontaneous (Group II) or thrombolysis-induced reperfusion (Group III), to determine infarction probability-based viability thresholds and prediction accuracies. The infarction probability difference between irreversible-i.e., infarcted after reperfusionand salvageable tissue injury-i.e., noninfarcted after reperfusion-was largest for GLM (20±7%) with highest accuracy of riskbased identification of acutely ischemic tissue that could recover on subsequent reperfusion (Dice's similarity index ¼ 0.79±0.14). Our study shows that assessment of the heterogeneity of infarction probability with MRI-based algorithms enables estimation of the extent of potentially salvageable tissue after acute ischemic stroke.

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Section: Introductionmentioning

confidence: 99%

Early Identification of Potentially Salvageable Tissue with MRI-Based Predictive Algorithms after Experimental Ischemic Stroke

Bouts

Tiebosch

Toorn

et al. 2013

J Cereb Blood Flow Metab

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“…19 -23 In infarcted cerebral parenchyma, the autoregulation mechanisms are altered, and both the rCBF and rCBV are usually decreased. 8,9 Penumbra and infarct maps can thus be inferred from rCBV and rCBF maps and could perhaps be used as an additional criterion to decide whether an acute stroke patient should be included in a thrombolysis protocol, since thrombolysis performed on patients with extensive cerebral infarct and a limited penumbra would not only be of little benefit, but also increase the risk of intracranial bleeding.…”

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confidence: 99%

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Wintermark¹,

Reichhart²,

Thiran

et al. 2002

Annals of Neurology

460

283

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The purpose of this study was to determine the prognostic accuracy of perfusion computed tomography (CT), performed at the time of emergency room admission, in acute stroke patients. Accuracy was determined by comparison of perfusion CT with delayed magnetic resonance (MR) and by monitoring the evolution of each patient's clinical condition. Twentytwo acute stroke patients underwent perfusion CT covering four contiguous 10mm slices on admission, as well as delayed MR, performed after a median interval of 3 days after emergency room admission. Eight were treated with thrombolytic agents. Infarct size on the admission perfusion CT was compared with that on the delayed diffusion-weighted (DWI)-MR, chosen as the gold standard. Delayed magnetic resonance angiography and perfusion-weighted MR were used to detect recanalization. A potential recuperation ratio, defined as PRR ‫؍‬ penumbra size/(penumbra size ؉ infarct size) on the admission perfusion CT, was compared with the evolution in each patient's clinical condition, defined by the National Institutes of Health Stroke Scale (NIHSS). In the 8 cases with arterial recanalization, the size of the cerebral infarct on the delayed DWI-MR was larger than or equal to that of the infarct on the admission perfusion CT, but smaller than or equal to that of the ischemic lesion on the admission perfusion CT; and the observed improvement in the NIHSS correlated with the PRR (correlation coefficient ‫؍‬ 0.833). In the 14 cases with persistent arterial occlusion, infarct size on the delayed DWI-MR correlated with ischemic lesion size on the admission perfusion CT (r ‫؍‬ 0.958). In all 22 patients, the admission NIHSS correlated with the size of the ischemic area on the admission perfusion CT (r ‫؍‬ 0.627). Based on these findings, we conclude that perfusion CT allows the accurate prediction of the final infarct size and the evaluation of clinical prognosis for acute stroke patients at the time of emergency evaluation. It may also provide information about the extent of the penumbra. Perfusion CT could therefore be a valuable tool in the early management of acute stroke patients.

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“…본 연구 [5], [6] . 또한 CBV지도는 측부 혈류량을 아주 잘 반영하 며, 최종 뇌경색크기와 일치율이 상당히 높은 것으로 알려져 있다고 보고한 바도 있다 [24] . 재개통된 경우에도 볼 수 있다고 했다 [14], [26] .…”

Section: 관류Ct의 네 가지 지도와 Dw-mr영상의 병변 면적unclassified

“…TTP지도의 장점은 영상을 얻기가 쉽고 후처리 과정에 시간이 적게 걸리며 병변부위와 정상 부위의 구별이 명확하게 드러난다는 점이다 [9] . 그러나 단점으로는 뇌관류의 간접적인 측정방법으로 급성 허 혈 없이 만성적인 경동맥 협착환자에서 TTP의 지연이 나타날 수 있어 급성허혈의 위험지역을 과대측정 할 수 있다 [9], [22], [24] . CBF지도에서 정상을 보이나 MTT 또 는 TTP지도에서 관류지연으로 나타나는 경우는 조영 제의 평균통과시간이나 최대농도 도달시간이 지연되 어 있지만, 측부순환의 발달로 인하여 정상부위와 비 슷한 정도의 뇌혈류량을 갖고 있는, 아직 경색에까지 이르지는 않은 부위로 해석할 수 있다 [22], [24] .…”

Section: 관류Ct의 네 가지 지도와 Dw-mr영상의 병변 면적unclassified

“…그러나 단점으로는 뇌관류의 간접적인 측정방법으로 급성 허 혈 없이 만성적인 경동맥 협착환자에서 TTP의 지연이 나타날 수 있어 급성허혈의 위험지역을 과대측정 할 수 있다 [9], [22], [24] . CBF지도에서 정상을 보이나 MTT 또 는 TTP지도에서 관류지연으로 나타나는 경우는 조영 제의 평균통과시간이나 최대농도 도달시간이 지연되 어 있지만, 측부순환의 발달로 인하여 정상부위와 비 슷한 정도의 뇌혈류량을 갖고 있는, 아직 경색에까지 이르지는 않은 부위로 해석할 수 있다 [22], [24] . 급성뇌경 색 환자에서는 TTP가 경색이 아니라 주로 뇌의 허혈 상태를 반영하는 뇌의 허혈변화, 즉 허혈 반음영 (ischemic penumbra)을 의미하고, CBV가 경색의 중심부 를 반영한다고 알려져 있다 [29], [30] .…”

Section: 관류Ct의 네 가지 지도와 Dw-mr영상의 병변 면적unclassified

See 1 more Smart Citation

The functional imaging to Diagnose Acute Cerebral infarction Comparing between CT Perfusion and MR Diffusion Imaging

Kim¹,

Eun²,

Rim³

2012

Journal of the Korean Society of Radiology

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It is very important for early diagnosis and therapy with ischamic cerebral infarction patients.This study was to know the ischemic penumbra lesion which compared CT-perfusion and diffusion weighted MRI(DWMRI) with acute cerebral infarction patients. 12 acute cerebral infarction patients had performed perfusion CT and performed DWMRI. Perfusion images including cerebral blood volume(CBV), cerebral blood flow(CBF), time to peak(TTP) and mean transit time(MTT) maps obtained the values with defect lesion and contralateral normal cerebral hemisphere and DWMRI was measured by signal intensity and compared of lesion size between each perfusion map.All perfusion CT maps showed the perfusion defect lesions in all patients. There were remarkable TTP and MTT delay in perfusion defect lesions. The lesions on CBF map was the most closely correlated with the lesions on DWMRI. The size of perfusion defect lesions on TTP and MTT map was larger than that of lesions on DWMRI, suggesting that MTT map can evaluate the ischemic penumbra. Perfusion CT maps make it

show abstract

Hyperacute Stroke: Simultaneous Measurement of Relative Cerebral Blood Volume, Relative Cerebral Blood Flow, and Mean Tissue Transit Time

Abstract: MR imaging can delineate areas of altered blood flow, blood volume, and water mobility in hyperacute human stroke. Predictive models of tissue outcome may benefit by including computation of both relative cerebral blood flow and blood volume.

Cited by 375 publications

References 22 publications

Early Identification of Potentially Salvageable Tissue with MRI-Based Predictive Algorithms after Experimental Ischemic Stroke

Early Identification of Potentially Salvageable Tissue with MRI-Based Predictive Algorithms after Experimental Ischemic Stroke

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

The functional imaging to Diagnose Acute Cerebral infarction Comparing between CT Perfusion and MR Diffusion Imaging

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