Perfusion-weighted magnetic resonance imaging thresholds identifying core, irreversibly infarcted tissue

Ludy C. Shih, Jeffrey L. Saver, Jeffry R. Alger, Sidney Starkman, Megan C. Leary, Fernando Vinuela, Gary Duckwiler, Y. Pierre Gobin, Reza Jahan, J. Pablo Villablanca, Paul M. Vespa, Stella Kidwell

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Background and Purpose - Identifying core, irreversibly infarcted tissue and salvageable penumbral tissue is crucial to informed, physiologically guided decision making regarding thrombolytic and other interventional therapies in acute ischemic stroke. Pretreatment perfusion MRI offers promise as a means to differentiate core from penumbral tissues. Methods - Diffusion-perfusion MRIs were performed before treatment and on day 7 in patients undergoing successful vessel recanalization with intra-arterial thrombolytic therapy. Perfusion maps of the time to peak of the residue function (Tmax) were generated after deconvolution of an arterial input function. Initial perfusion abnormalities and final infarct regions were outlined by hand. Posttreatment images were coregistered to the pretreatment study. Voxel-by-voxel and volume analyses were performed to identify thresholds of perfusion abnormalities that best predict core, irreversibly infarcted tissue. Results - Fourteen patients (4 men, 10 women) with vessel recanalization were studied. Mean age was 73 years, and median entry National Institutes of Health Stroke Scale score was 12. Mean time from symptom onset to start of intra-arterial infusion was 245 minutes and to recanalization was 338 minutes. With a voxel-by-voxel analysis, Tmax ≥6 and ≥8 seconds (sensitivity, 71% and 53%; specificity, 63% and 80%) correlated most highly with day 7 final infarct. With a volume analysis, Tmax of ≥6 and ≥8 seconds (r2=0.704 and r2=0.705) correlated most highly with day 7 final infarct. Conclusions - Perfusion-weighted imaging measures of ischemia severity accurately differentiate irreversibly injured core from penumbral, salvageable tissue. The best threshold for identifying core infarcted tissue is adjusted Tmax of ≥6 to 8 seconds.

Original languageEnglish (US)
Pages (from-to)1425-1430
Number of pages6
JournalStroke
Volume34
Issue number6
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

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Magnetic Resonance Angiography
Perfusion
Stroke
Intra Arterial Infusions
Diffusion Magnetic Resonance Imaging
Perfusion Imaging
Thrombolytic Therapy
National Institutes of Health (U.S.)
Decision Making
Ischemia
Hand
Therapeutics

Keywords

  • Magnetic resonance imaging, perfusion weighted
  • Stroke, acute
  • Stroke, ischemic
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Perfusion-weighted magnetic resonance imaging thresholds identifying core, irreversibly infarcted tissue. / Shih, Ludy C.; Saver, Jeffrey L.; Alger, Jeffry R.; Starkman, Sidney; Leary, Megan C.; Vinuela, Fernando; Duckwiler, Gary; Gobin, Y. Pierre; Jahan, Reza; Villablanca, J. Pablo; Vespa, Paul M.; Kidwell, Stella.

In: Stroke, Vol. 34, No. 6, 01.06.2003, p. 1425-1430.

Research output: Contribution to journalArticle

Shih, LC, Saver, JL, Alger, JR, Starkman, S, Leary, MC, Vinuela, F, Duckwiler, G, Gobin, YP, Jahan, R, Villablanca, JP, Vespa, PM & Kidwell, S 2003, 'Perfusion-weighted magnetic resonance imaging thresholds identifying core, irreversibly infarcted tissue', Stroke, vol. 34, no. 6, pp. 1425-1430. https://doi.org/10.1161/01.STR.0000072998.70087.E9
Shih, Ludy C. ; Saver, Jeffrey L. ; Alger, Jeffry R. ; Starkman, Sidney ; Leary, Megan C. ; Vinuela, Fernando ; Duckwiler, Gary ; Gobin, Y. Pierre ; Jahan, Reza ; Villablanca, J. Pablo ; Vespa, Paul M. ; Kidwell, Stella. / Perfusion-weighted magnetic resonance imaging thresholds identifying core, irreversibly infarcted tissue. In: Stroke. 2003 ; Vol. 34, No. 6. pp. 1425-1430.
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AU - Shih, Ludy C.

AU - Saver, Jeffrey L.

AU - Alger, Jeffry R.

AU - Starkman, Sidney

AU - Leary, Megan C.

AU - Vinuela, Fernando

AU - Duckwiler, Gary

AU - Gobin, Y. Pierre

AU - Jahan, Reza

AU - Villablanca, J. Pablo

AU - Vespa, Paul M.

AU - Kidwell, Stella

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AB - Background and Purpose - Identifying core, irreversibly infarcted tissue and salvageable penumbral tissue is crucial to informed, physiologically guided decision making regarding thrombolytic and other interventional therapies in acute ischemic stroke. Pretreatment perfusion MRI offers promise as a means to differentiate core from penumbral tissues. Methods - Diffusion-perfusion MRIs were performed before treatment and on day 7 in patients undergoing successful vessel recanalization with intra-arterial thrombolytic therapy. Perfusion maps of the time to peak of the residue function (Tmax) were generated after deconvolution of an arterial input function. Initial perfusion abnormalities and final infarct regions were outlined by hand. Posttreatment images were coregistered to the pretreatment study. Voxel-by-voxel and volume analyses were performed to identify thresholds of perfusion abnormalities that best predict core, irreversibly infarcted tissue. Results - Fourteen patients (4 men, 10 women) with vessel recanalization were studied. Mean age was 73 years, and median entry National Institutes of Health Stroke Scale score was 12. Mean time from symptom onset to start of intra-arterial infusion was 245 minutes and to recanalization was 338 minutes. With a voxel-by-voxel analysis, Tmax ≥6 and ≥8 seconds (sensitivity, 71% and 53%; specificity, 63% and 80%) correlated most highly with day 7 final infarct. With a volume analysis, Tmax of ≥6 and ≥8 seconds (r2=0.704 and r2=0.705) correlated most highly with day 7 final infarct. Conclusions - Perfusion-weighted imaging measures of ischemia severity accurately differentiate irreversibly injured core from penumbral, salvageable tissue. The best threshold for identifying core infarcted tissue is adjusted Tmax of ≥6 to 8 seconds.

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KW - Stroke, acute

KW - Stroke, ischemic

KW - Thrombolysis

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