Usefulness of Magnetic Resonance–Derived Quantitative Measurements of Cerebral Blood Flow and Volume in Prediction of Infarct Growth in Hyperacute Stroke
- 1 May 2001
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 32 (5), 1147-1153
- https://doi.org/10.1161/01.str.32.5.1147
Abstract
Background and Purpose —The identification of the tissue at risk for infarction remains challenging in stroke patients. In this study, we evaluated the value of quantitative cerebral blood flow (CBF) and cerebral blood volume (CBV) measurements in the prediction of infarct growth in hyperacute stroke. Methods —Fluid-attenuated inversion recovery (FLAIR), diffusion-weighted (DW), and gradient-echo echo-planar perfusion-weighted (PW) sequences were obtained in 66 patients within 6 hours of stroke onset; ischemia was confirmed on follow-up FLAIR images. We delineated the following: (1) the initial infarct on DW images, (2) the area of hemodynamic disturbance on mean transit time (MTT) maps, and (3) the final infarct on follow-up FLAIR images. MTT, CBF, and CBV were calculated in the following areas: area of initial infarct (INF), area of infarct growth (IGR, final minus initial infarct), the hemodynamically disturbed area that remained viable (OLI, hemodynamic disturbance minus final infarct), and all contralateral mirror regions. Results —Compared with mirror regions, the MTT in abnormal areas was always prolonged. The respective mean±SD CBF and CBV values were as follows: for INF, 28±16 mL/min per 100 g and 6.9±2.7%; for IGR, 36±20 mL/min per 100 g and 8.9±3.1%; for OLI, 50±17 mL/min per 100 g and 11.2±3%; and for mirror regions, 64±23 mL/min per 100 g and 8.7±2.5%. The CBV and CBF values were significantly different between all abnormal areas (except for the CBF between INF and IGR). In the area of DW/PW mismatch, a combined CBF or CBV threshold of 35 or 8.2, respectively, predicted evolution to infarction with a sensitivity of 81% and a specificity of 76%. Conclusions —Quantitative measurements of CBF and CBV in hyperacute stroke may help to predict infarct growth and to select the subjects who will benefit from thrombolysis.This publication has 17 references indexed in Scilit:
- Whole brain quantitative CBF, CBV, and MTT measurements using MRI bolus tracking: Implementation and application to data acquired from hyperacute stroke patientsJournal of Magnetic Resonance Imaging, 2000
- Cerebral Hemodynamics in Human Acute Ischemic Stroke: A Study with Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging and SPECTJournal of Cerebral Blood Flow & Metabolism, 2000
- Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRIThe Lancet, 1999
- Outcome in Acute Stroke with Successful Intra-Arterial Thrombolysis and Predictive Value of Initial Single-Photon Emission-Computed TomographyJournal of Cerebral Blood Flow & Metabolism, 1999
- High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysisMagnetic Resonance in Medicine, 1996
- Correlation of the Average Water Diffusion Constant with Cerebral Blood Flow and Ischemic Damage after Transient Middle Cerebral Artery Occlusion in CatsJournal of Cerebral Blood Flow & Metabolism, 1996
- Spontaneous neurological recovery after stroke and the fate of the ischemic penumbraAnnals of Neurology, 1996
- Clinical Outcome in Ischemic Stroke Predicted by Early Diffusion-Weighted and Perfusion Magnetic Resonance Imaging: A Preliminary AnalysisJournal of Cerebral Blood Flow & Metabolism, 1996
- Tissue Plasminogen Activator for Acute Ischemic StrokeNew England Journal of Medicine, 1995
- Determination of Irreversible Ischemia by Xenon-Enhanced Computed Tomographic Monitoring of Cerebral Blood Flow in Patients with Symptomatic VasospasmNeurosurgery, 1989