American Journal of Neuroradiology 26:815-819, April 2005
© 2005 American Society of Neuroradiology
BRAIN
Tissue at Risk Is Overestimated in Perfusion-Weighted Imaging: MR Imaging in Acute Stroke Patients without Vessel Recanalization
a Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
b Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
c Institute for Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
d University Hospital Berlin Charité, Berlin, Germany
Address correspondence to Thomas Kucinski, University-Hospital Hamburg Eppendorf, Department of Neuroradiology, Martinistrasse 52, 20251 Hamburg, Germany
BACKGROUND AND PURPOSE: The volume of decreased cerebral blood flow (CBF) in acute stroke perfusion-weighted imaging frequently overestimates final infarct volume. We hypothesized that surviving tissue exists even in patients without recanalization and tried to determine perfusion thresholds from initial MR imaging.
METHODS: Stroke MR imaging including MR angiography was carried out at days 0, 1, and 7 after stroke onset in 19 patients without recanalization at least until day 1. The following lesions were defined: L0 = diffusion restriction at day 0; LG1 = lesion growth until day 1; LG7 = lesion growth until day 7; ST7 = initially hypoperfused, but surviving tissue. These lesions were transferred on initial MR imaging within 4.7 hours and perfusion values at day 0 were determined.
RESULTS: Median lesion volume L0 at day 0 was 18.2 mL and increased to 39.4 and 43.8 mL at days 1 and 7. Volume of decreased rCBF not progressing to infarction was 148.5 mL (ST7). Mean ST7 perfusion values were different from L0 and LG1, but only mean relative cerebral blood volume (rCBV) was different from LG7, discriminating survival against death of tissue. A threshold value of 0.82 CBV for death versus survival was determined with a sensitivity of 0.56 and specificity of 0.95. Carotid T occlusions showed the greatest potential of lesion growth.
CONCLUSION: Even when vessel occlusion persists, hypoperfused tissue on MR imaging does not necessarily progress toward infarction. The most conclusive inferences can be drawn from CBV images. The site of arterial occlusion also determines progression to infarction.
This article has been cited by other articles:
 |
|
 |
|
  K. Kudo, M. Sasaki, K. Yamada, S. Momoshima, H. Utsunomiya, H. Shirato, and K. Ogasawara Differences in CT Perfusion Maps Generated by Different Commercial Software: Quantitative Analysis by Using Identical Source Data of Acute Stroke Patients Radiology, January 1, 2010; 254(1): 200 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Latchaw, M. J. Alberts, M. H. Lev, J. J. Connors, R. E. Harbaugh, R. T. Higashida, R. Hobson, C. S. Kidwell, W. J. Koroshetz, V. Mathews, et al. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association Stroke, November 1, 2009; 40(11): 3646 - 3678. [Full Text] [PDF]
|
|
|
|
|
|
S. Christensen, K. Mouridsen, O. Wu, N. Hjort, H. Karstoft, G. Thomalla, J. Rother, J. Fiehler, T. Kucinski, and L. Ostergaard Comparison of 10 Perfusion MRI Parameters in 97 Sub-6-Hour Stroke Patients Using Voxel-Based Receiver Operating Characteristics Analysis Stroke, June 1, 2009; 40(6): 2055 - 2061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Siemonsen, T. Fitting, G. Thomalla, P. Horn, J. Finsterbusch, P. Summers, C. Saager, T. Kucinski, and J. Fiehler T2' Imaging Predicts Infarct Growth beyond the Acute Diffusion-weighted Imaging Lesion in Acute Stroke Radiology, September 1, 2008; 248(3): 979 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Geisler, F. Brandhoff, J. Fiehler, C. Saager, O. Speck, J. Rother, H. Zeumer, and T. Kucinski Blood Oxygen Level-Dependent MRI Allows Metabolic Description of Tissue at Risk in Acute Stroke Patients Stroke, July 1, 2006; 37(7): 1778 - 1784. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.D. Murphy, A.J. Fox, D.H. Lee, D.J. Sahlas, S.E. Black, M.J. Hogan, S.B. Coutts, A.M. Demchuk, M. Goyal, R.I. Aviv, et al. Identification of Penumbra and Infarct in Acute Ischemic Stroke Using Computed Tomography Perfusion-Derived Blood Flow and Blood Volume Measurements Stroke, July 1, 2006; 37(7): 1771 - 1777. [Abstract] [Full Text] [PDF]
|
|