1
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Valable S, Toutain J, Divoux D, Chazalviel L, Corroyer-Dulmont A, Chakhoyan A, Guillouet S, Bernaudin M, Barbier EL, Touzani O. Magnetic resonance imaging of hypoxia in acute stroke compared with fluorine-18 fluoromisonidazole-positron emission tomography: A cross-validation study? NMR IN BIOMEDICINE 2023; 36:e4858. [PMID: 36285719 DOI: 10.1002/nbm.4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
Acute ischemic stroke results in an ischemic core surrounded by a tissue at risk, named the penumbra, which is potentially salvageable. One way to differentiate the tissues is to measure the hypoxia status. The purpose of the current study is to correlate the abnormal brain tissue volume derived from magnetic resonance-based imaging of brain oxygen saturation (St O2 -MRI) to the fluorine-18 fluoromisonidazole ([18 F]FMISO) positron emission tomography (PET) volume for hypoxia imaging validation, and to analyze the ability of St O2 -MRI to depict the different hypoxic tissue types in the acute phase of stroke. In a pertinent model of stroke in the rat, the volume of tissue with decreased St O2 -MRI signal and that with increased uptake of [18 F]FMISO were equivalent and correlated (r = 0.706; p = 0.015). The values of St O2 in the tissue at risk were significantly greater than those quantified in the core of the lesion, and were less than those for healthy tissue (52.3% ± 2.0%; 43.3% ± 1.9%, and 67.9 ± 1.4%, respectively). A threshold value for St O2 of ≈60% as the cut-off for the identification of the tissue at risk was calculated. Tissue volumes with reduced St O2 -MRI correlated with the final lesion (r = 0.964, p < 0.0001). The findings show that the St O2 -MRI approach is sensitive for the detection of hypoxia and for the prediction of the final lesion after stroke. Once validated in acute clinical settings, this approach might be used to enhance the stratification of patients for potential therapeutic interventions.
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Affiliation(s)
- Samuel Valable
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | - Jérôme Toutain
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | - Didier Divoux
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | - Laurent Chazalviel
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | | | - Ararat Chakhoyan
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | - Stéphane Guillouet
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/LDM-TEP group, Caen, France
| | - Myriam Bernaudin
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
| | - Emmanuel L Barbier
- Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, Grenoble, France
| | - Omar Touzani
- Normandie-Univ, UNICAEN, CEA, CNRS, GIP CYCERON, ISTCT/CERVOxy group, Caen, France
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2
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Gómez-Lado N, López-Arias E, Iglesias-Rey R, Díaz-Platas L, Medín-Aguerre S, Fernández-Ferreiro A, Posado-Fernández A, García-Varela L, Rodríguez-Pérez M, Campos F, Del Pino P, Ruibal Á, Pardo-Montero J, Castillo J, Aguiar P, Sobrino T. [ 18F]-FMISO PET/MRI Imaging Shows Ischemic Tissue around Hematoma in Intracerebral Hemorrhage. Mol Pharm 2020; 17:4667-4675. [PMID: 33186043 DOI: 10.1021/acs.molpharmaceut.0c00932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intracerebral hemorrhage (ICH), being the most severe cerebrovascular disease, accounts for 10-15% of all strokes. Hematoma expansion is one of the most important factors associated with poor outcome in intracerebral hemorrhage (ICH). Several studies have suggested that an "ischemic penumbra" might arise when the hematoma has a large expansion, but clinical studies are inconclusive. We performed a preclinical study to demonstrate the presence of hypoxic-ischemic tissue around the hematoma by means of longitudinal [18F]-fluoromisonidazole ([18F]-FMISO) PET/MRI studies over time in an experimental ICH model. Our results showed that all [18F]-FMISO PET/MRI images exhibited hypoxic-ischemic tissue around the hematoma area. A significant increase of [18F]-FMISO uptake was found at 18-24 h post-ICH when the maximum of hematoma volume is achieved and this increase disappeared before 42 h. These results demonstrate the presence of hypoxic tissue around the hematoma and open the possibility of new therapies aimed to reduce ischemic damage associated with ICH.
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Affiliation(s)
- Noemí Gómez-Lado
- Molecular Imaging Research Group, Nuclear Medicine Department, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain.,Molecular Imaging and Medical Physics Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, University of Santiago de Compostela (USC), University Clinical Hospital, Santiago de Compostela 15706, Spain
| | - Esteban López-Arias
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Ramón Iglesias-Rey
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Lucía Díaz-Platas
- Galician PET Radiopharmacy Unit, GALARIA, University Clinical Hospital, Santiago de Compostela 15706, Spain
| | - Santiago Medín-Aguerre
- Galician PET Radiopharmacy Unit, GALARIA, University Clinical Hospital, Santiago de Compostela 15706, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacology Group, Pharmacy Department, University Clinical Hospital, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Adrián Posado-Fernández
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Lara García-Varela
- Molecular Imaging Research Group, Nuclear Medicine Department, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Manuel Rodríguez-Pérez
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Pablo Del Pino
- Center for Research in Biological Chemistry and Molecular Materials (CIQUS), Particle Physics Departament, University of Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Álvaro Ruibal
- Molecular Imaging Research Group, Nuclear Medicine Department, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain.,Molecular Imaging and Medical Physics Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, University of Santiago de Compostela (USC), University Clinical Hospital, Santiago de Compostela 15706, Spain
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Pablo Aguiar
- Molecular Imaging Research Group, Nuclear Medicine Department, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain.,Molecular Imaging and Medical Physics Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, University of Santiago de Compostela (USC), University Clinical Hospital, Santiago de Compostela 15706, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
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3
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Warpsinski G, Smith MJ, Srivastava S, Keeley TP, Siow RCM, Fraser PA, Mann GE. Nrf2-regulated redox signaling in brain endothelial cells adapted to physiological oxygen levels: Consequences for sulforaphane mediated protection against hypoxia-reoxygenation. Redox Biol 2020; 37:101708. [PMID: 32949969 PMCID: PMC7502377 DOI: 10.1016/j.redox.2020.101708] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke is associated with a surge in reactive oxygen species generation during reperfusion. The narrow therapeutic window for the delivery of intravenous thrombolysis and endovascular thrombectomy limits therapeutic options for patients. Thus, understanding the mechanisms regulating neurovascular redox defenses are key for improved clinical translation. Our previous studies in a rodent model of ischemic stroke established that activation of Nrf2 defense enzymes by pretreatment with sulforaphane (SFN) affords protection against neurovascular and neurological deficits. We here further investigate SFN mediated protection in mouse brain microvascular endothelial cells (bEnd.3) adapted long-term (5 days) to hyperoxic (18 kPa) and normoxic (5 kPa) O2 levels. Using an O2-sensitive phosphorescent nanoparticle probe, we measured an intracellular O2 level of 3.4 ± 0.1 kPa in bEnd 3 cells cultured under 5 kPa O2. Induction of HO-1 and GCLM by SFN (2.5 μM) was significantly attenuated in cells adapted to 5 kPa O2, despite nuclear accumulation of Nrf2. To simulate ischemic stroke, bEnd.3 cells were adapted to 18 or 5 kPa O2 and subjected to hypoxia (1 kPa O2, 1 h) and reoxygenation. In cells adapted to 18 kPa O2, reoxygenation induced free radical generation was abrogated by PEG-SOD and significantly attenuated by pretreatment with SFN (2.5 μM). Silencing Nrf2 transcription abrogated HO-1 and NQO1 induction and led to a significant increase in reoxygenation induced free radical generation. Notably, reoxygenation induced oxidative stress, assayed using the luminescence probe L-012 and fluorescence probes MitoSOX™ Red and FeRhoNox™-1, was diminished in cells cultured under 5 kPa O2, indicating an altered redox phenotype in brain microvascular cells adapted to physiological normoxia. As redox and other intracellular signaling pathways are critically affected by O2, the development of antioxidant therapies targeting the Keap1-Nrf2 defense pathway in treatment of ischemia-reperfusion injury in stroke, coronary and renal disease will require in vitro studies conducted under well-defined O2 levels. Physiological normoxia alters the redox phenotype of murine microvascular brain endothelial cells. Intracellular GSH levels are lower in bEnd.3 cells adapted to 5 kPa versus 18 kPa O2. Nrf2 activated HO-1 and GCLM expression is attenuated under physiological normoxia. Sulforaphane protects against reoxygenation induced reactive oxygen species generation via Nrf2.
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Affiliation(s)
- Gabriela Warpsinski
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Matthew J Smith
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Salil Srivastava
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Thomas P Keeley
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Richard C M Siow
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Paul A Fraser
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Giovanni E Mann
- King's British Heart Foundation Centre for Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK.
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4
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Ng FC, Coulton B, Chambers B, Thijs V. Persistently Elevated Microvascular Resistance Postrecanalization. Stroke 2018; 49:2512-2515. [DOI: 10.1161/strokeaha.118.021631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Purpose—
Impaired microvascular reperfusion despite complete recanalization (no-reflow) represents a potential therapeutic target to improve outcomes after recanalization therapies. Although well documented in animal models, this phenomenon has not been demonstrated clinically. We investigated whether transcranial Doppler can detect acute microvascular changes postrecanalization as a biomarker of the no-reflow phenomenon in stroke patients.
Methods—
Consecutive patients with recanalized (Thrombolysis in Cerebral Infarction grade IIb/III) acute middle cerebral artery occlusion by thrombectomy at a Comprehensive Stroke Centre with a high-volume neurovascular laboratory were retrospectively identified. Sonographic measures of middle cerebral artery territory microvascular resistance (pulsatility index and resistive index) on days 1 to 3 follow-up transcranial Doppler were compared between patients and age/gender-matched controls.
Results—
In 53 patients, middle cerebral artery pulsatility index was significantly more likely to be asymmetrically increased on interside comparison (27.9% versus 4.9%;
P
=0.007) and abnormally elevated beyond normal reference ranges (46.7% versus 22.0%;
P
=0.016) in the symptomatic hemisphere. Middle cerebral artery pulsatility index elevation was associated with less hemorrhagic infarction (9.5% versus 45.8%;
P
=0.009) but worse functional outcome irrespective of infarct volume as assessed on 90-day modified Rankin Scale (score of ≤1, 18.2% versus 58.1%;
P
=0.035).
Conclusions—
Elevated microvascular resistance within the ischemic territory is commonly present after successful recanalization as measured by pulsatility index on transcranial Doppler and may be a readily available and clinically relevant biomarker of the no-reflow phenomenon.
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Affiliation(s)
- Felix C. Ng
- From the Department of Neurology, Austin Health, Heidelberg, Australia (F.C.N., B.C., B.C., V.T.)
| | - Bronwyn Coulton
- From the Department of Neurology, Austin Health, Heidelberg, Australia (F.C.N., B.C., B.C., V.T.)
| | - Brian Chambers
- From the Department of Neurology, Austin Health, Heidelberg, Australia (F.C.N., B.C., B.C., V.T.)
- Department of Medicine, University of Melbourne, Australia (B.C.)
| | - Vincent Thijs
- From the Department of Neurology, Austin Health, Heidelberg, Australia (F.C.N., B.C., B.C., V.T.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (V.T.)
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5
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Choi CH, Yi KS, Lee SR, Lee Y, Jeon CY, Hwang J, Lee C, Choi SS, Lee HJ, Cha SH. A novel voxel-wise lesion segmentation technique on 3.0-T diffusion MRI of hyperacute focal cerebral ischemia at 1 h after permanent MCAO in rats. J Cereb Blood Flow Metab 2018; 38:1371-1383. [PMID: 28598225 PMCID: PMC6092770 DOI: 10.1177/0271678x17714179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To assess hyperacute focal cerebral ischemia in rats on 3.0-Tesla diffusion-weighted imaging (DWI), we developed a novel voxel-wise lesion segmentation technique that overcomes intra- and inter-subject variation in apparent diffusion coefficient (ADC) distribution. Our novel technique involves the following: (1) intensity normalization including determination of the optimal type of region of interest (ROI) and its intra- and inter-subject validation, (2) verification of focal cerebral ischemic lesions at 1 h with gross and high-magnification light microscopy of hematoxylin-eosin (H&E) pathology, (3) voxel-wise segmentation on ADC with various thresholds, and (4) calculation of dice indices (DIs) to compare focal cerebral ischemic lesions at 1 h defined by ADC and matching H&E pathology. The best coefficient of variation was the mode of the left hemisphere after normalization using whole left hemispheric ROI, which showed lower intra- (2.54 ± 0.72%) and inter-subject (2.67 ± 0.70%) values than the original. Focal ischemic lesion at 1 h after middle cerebral artery occlusion (MCAO) was confirmed on both gross and microscopic H&E pathology. The 83 relative threshold of normalized ADC showed the highest mean DI (DI = 0.820 ± 0.075). We could evaluate hyperacute ischemic lesions at 1 h more reliably on 3-Tesla DWI in rat brains.
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Affiliation(s)
- Chi-Hoon Choi
- 1 Department of Radiology, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Kyung Sik Yi
- 1 Department of Radiology, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sang-Rae Lee
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Youngjeon Lee
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Chang-Yeop Jeon
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Jinwoo Hwang
- 3 Clinical Science, Philips Healthcare, Seoul, Republic of Korea
| | - Chulhyun Lee
- 4 Bioimaging Research Team, Korea Basic Science Institute, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sung Sik Choi
- 5 Medical Research Institute, Chung-Ang University, Seoul, Republic of Korea
| | - Hong Jun Lee
- 5 Medical Research Institute, Chung-Ang University, Seoul, Republic of Korea
| | - Sang-Hoon Cha
- 1 Department of Radiology, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea.,6 College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
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6
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Fernandez-Maza L, Egea-Guerrero JJ, Balcerzyk M, Civantos-Jubera G, Gordillo-Escobar E, Vilches-Arenas A, Fernandez-Gomez I, Parrado-Gallego A, Murillo-Cabezas F. Rapid and simplified synthesis of [ 18 F]Fluoromisonidazole and its use in PET imaging in an experimental model of subarachnoid hemorrhage. Appl Radiat Isot 2018; 132:79-84. [DOI: 10.1016/j.apradiso.2017.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
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7
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Effects of hyperoxia on 18F-fluoro-misonidazole brain uptake and tissue oxygen tension following middle cerebral artery occlusion in rodents: Pilot studies. PLoS One 2017; 12:e0187087. [PMID: 29091934 PMCID: PMC5665507 DOI: 10.1371/journal.pone.0187087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 10/15/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Mapping brain hypoxia is a major goal for stroke diagnosis, pathophysiology and treatment monitoring. 18F-fluoro-misonidazole (FMISO) positron emission tomography (PET) is the gold standard hypoxia imaging method. Normobaric hyperoxia (NBO) is a promising therapy in acute stroke. In this pilot study, we tested the straightforward hypothesis that NBO would markedly reduce FMISO uptake in ischemic brain in Wistar and spontaneously hypertensive rats (SHRs), two rat strains with distinct vulnerability to brain ischemia, mimicking clinical heterogeneity. METHODS Thirteen adult male rats were randomized to distal middle cerebral artery occlusion under either 30% O2 or 100% O2. FMISO was administered intravenously and PET data acquired dynamically for 3hrs, after which magnetic resonance imaging (MRI) and tetrazolium chloride (TTC) staining were carried out to map the ischemic lesion. Both FMISO tissue uptake at 2-3hrs and FMISO kinetic rate constants, determined based on previously published kinetic modelling, were obtained for the hypoxic area. In a separate group (n = 9), tissue oxygen partial pressure (PtO2) was measured in the ischemic tissue during both control and NBO conditions. RESULTS As expected, the FMISO PET, MRI and TTC lesion volumes were much larger in SHRs than Wistar rats in both the control and NBO conditions. NBO did not appear to substantially reduce FMISO lesion size, nor affect the FMISO kinetic rate constants in either strain. Likewise, MRI and TTC lesion volumes were unaffected. The parallel study showed the expected increases in ischemic cortex PtO2 under NBO, although these were small in some SHRs with very low baseline PtO2. CONCLUSIONS Despite small samples, the apparent lack of marked effects of NBO on FMISO uptake suggests that in permanent ischemia the cellular mechanisms underlying FMISO trapping in hypoxic cells may be disjointed from PtO2. Better understanding of FMISO trapping processes will be important for future applications of FMISO imaging.
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8
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Kleine JF, Kaesmacher M, Wiestler B, Kaesmacher J. Tissue-Selective Salvage of the White Matter by Successful Endovascular Stroke Therapy. Stroke 2017; 48:2776-2783. [DOI: 10.1161/strokeaha.117.017903] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/03/2017] [Accepted: 08/02/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Justus F. Kleine
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Germany (J.F.K., M.K., B.W., J.K.); and Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Germany (J.F.K.)
| | - Mirjam Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Germany (J.F.K., M.K., B.W., J.K.); and Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Germany (J.F.K.)
| | - Benedikt Wiestler
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Germany (J.F.K., M.K., B.W., J.K.); and Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Germany (J.F.K.)
| | - Johannes Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Germany (J.F.K., M.K., B.W., J.K.); and Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Germany (J.F.K.)
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9
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Abstract
Positron emission tomography (PET) is a minimally invasive imaging procedure with a wide range of clinical and research applications. PET allows for the three-dimensional mapping of administered positron-emitting radiopharmaceuticals such as (18)F-fluorodeoxyglucose (for imaging glucose metabolism). PET enables the study of biologic function in both health and disease, in contrast to magnetic resonance imaging (MRI) and computed tomography (CT), that are more suited to study a body's morphologic changes, although functional MRI can also be used to study certain brain functions by measuring blood flow changes during task performance. This chapter first provides an overview of the basic physics principles and instrumentation behind PET methodology, with an introduction to the merits of merging functional PET imaging with anatomic CT or MRI imaging. We then focus on clinical neurologic disorders, and reference research on relevant PET radiopharmaceuticals when applicable. We then provide an overview of PET scan interpretation and findings in several specific neurologic disorders such as dementias, epilepsy, movement disorders, infection, cerebrovascular disorders, and brain tumors.
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Affiliation(s)
- Katherine Lameka
- Department of Radiology, Tufts University, Boston and Department of Radiology, Baystate Medical Center, Springfield, MA, USA.
| | - Michael D Farwell
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Masanori Ichise
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Anagawa, Inage, Chiba, Japan
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10
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Dani KA, Warach S. Metabolic imaging of ischemic stroke: the present and future. AJNR Am J Neuroradiol 2014; 35:S37-43. [PMID: 24722308 DOI: 10.3174/ajnr.a3789] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Measures of cerebral metabolism may be useful in the selection of patients for reperfusion therapies and as end points in clinical trials. However, there are currently no clinically routine techniques that provide such data directly. We review how imaging modalities in current clinical use may provide surrogate markers of metabolic activity. Promising techniques for metabolic imaging that are currently in the pipeline are reviewed.
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Affiliation(s)
- K A Dani
- From the Institute of Neurosciences and Psychology (K.A.D.), University of Glasgow, Institute of Neurological Sciences, Glasgow, United Kingdom
| | - S Warach
- Department of Neurology and Neurotherapeutics (S.W.), UT Southwestern, Dallas, Texas.
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11
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Alawneh JA, Moustafa RR, Marrapu ST, Jensen-Kondering U, Morris RS, Jones PS, Aigbirhio FI, Fryer TD, Carpenter TA, Warburton EA, Baron JC. Diffusion and perfusion correlates of the 18F-MISO PET lesion in acute stroke: pilot study. Eur J Nucl Med Mol Imaging 2013; 41:736-44. [PMID: 24126468 DOI: 10.1007/s00259-013-2581-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/12/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Mapping the ischaemic penumbra in acute stroke is of considerable clinical interest. For this purpose, mapping tissue hypoxia with (18)F-misonidazole (FMISO) PET is attractive, and is straightforward compared to (15)O PET. Given the current emphasis on penumbra imaging using diffusion/perfusion MR or CT perfusion, investigating the relationships between FMISO uptake and abnormalities with these modalities is important. METHODS According to a prospective design, three patients (age 54-81 years; admission NIH stroke scale scores 16-22) with an anterior circulation stroke and extensive penumbra on CT- or MR-based perfusion imaging successfully completed FMISO PET, diffusion-weighted imaging and MR angiography 6-26 h after stroke onset, and follow-up FLAIR to map the final infarction. All had persistent proximal occlusion and a poor outcome despite thrombolysis. Significant FMISO trapping was defined voxel-wise relative to ten age-matched controls and mapped onto coregistered maps of the penumbra and irreversibly damaged ischaemic core. RESULTS FMISO trapping was present in all patients (volume range 18-119 ml) and overlapped mainly with the penumbra but also with the core in each patient. There was a significant (p ≤ 0.001) correlation in the expected direction between FMISO uptake and perfusion, with a sharp FMISO uptake bend around the expected penumbra threshold. CONCLUSION FMISO uptake had the expected overlap with the penumbra and relationship with local perfusion. However, consistent with recent animal data, our study suggests FMISO trapping may not be specific to the penumbra. If confirmed in larger samples, this preliminary finding would have potential implications for the clinical application of FMISO PET in acute ischaemic stroke.
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Affiliation(s)
- Josef A Alawneh
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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12
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Ström JO, Ingberg E, Theodorsson A, Theodorsson E. Method parameters' impact on mortality and variability in rat stroke experiments: a meta-analysis. BMC Neurosci 2013; 14:41. [PMID: 23548160 PMCID: PMC3637133 DOI: 10.1186/1471-2202-14-41] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/22/2013] [Indexed: 12/14/2022] Open
Abstract
Background Even though more than 600 stroke treatments have been shown effective in preclinical studies, clinically proven treatment alternatives for cerebral infarction remain scarce. Amongst the reasons for the discrepancy may be methodological shortcomings, such as high mortality and outcome variability, in the preclinical studies. A common approach in animal stroke experiments is that A) focal cerebral ischemia is inflicted, B) some type of treatment is administered and C) the infarct sizes are assessed. However, within this paradigm, the researcher has to make numerous methodological decisions, including choosing rat strain and type of surgical procedure. Even though a few studies have attempted to address the questions experimentally, a lack of consensus regarding the optimal methodology remains. Methods We therefore meta-analyzed data from 502 control groups described in 346 articles to find out how rat strain, procedure for causing focal cerebral ischemia and the type of filament coating affected mortality and infarct size variability. Results The Wistar strain and intraluminal filament procedure using a silicone coated filament was found optimal in lowering infarct size variability. The direct and endothelin methods rendered lower mortality rate, whereas the embolus method increased it compared to the filament method. Conclusions The current article provides means for researchers to adjust their middle cerebral artery occlusion (MCAo) protocols to minimize infarct size variability and mortality.
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Affiliation(s)
- Jakob O Ström
- Department of Clinical and Experimental Medicine, Clinical Chemistry, Faculty of Health Sciences, Linköping University, County Council of Östergötland, Linköping, Sweden.
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Baron JC, Jones T. Oxygen metabolism, oxygen extraction and positron emission tomography: Historical perspective and impact on basic and clinical neuroscience. Neuroimage 2012; 61:492-504. [DOI: 10.1016/j.neuroimage.2011.12.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/08/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022] Open
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Metabolic Imaging in Translational Stroke Research. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McLeod D. Letter to the editor: partial central retinal artery occlusion offers a unique insight into the ischemic penumbra. Clin Ophthalmol 2011; 6:9-22. [PMID: 22259231 PMCID: PMC3259095 DOI: 10.2147/opth.s28232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- David McLeod
- University of Manchester and Manchester Royal Eye Hospital, UK
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