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Reiländer A, Pilatus U, Schüre JR, Shrestha M, Deichmann R, Nöth U, Hattingen E, Gracien RM, Wagner M, Seiler A. Impaired oxygen extraction and adaptation of intracellular energy metabolism in cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100162. [PMID: 36851996 PMCID: PMC9957754 DOI: 10.1016/j.cccb.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND We aimed to investigate whether combined phosphorous (31P) magnetic resonance spectroscopic imaging (MRSI) and quantitative T 2 ' mapping are able to detect alterations of the cerebral oxygen extraction fraction (OEF) and intracellular pH (pHi) as markers the of cellular energy metabolism in cerebral small vessel disease (SVD). MATERIALS AND METHODS 32 patients with SVD and 17 age-matched healthy control subjects were examined with 3-dimensional 31P MRSI and oxygenation-sensitive quantitative T 2 ' mapping (1/ T 2 ' = 1/T2* - 1/T2) at 3 Tesla (T). PHi was measured within the white matter hyperintensities (WMH) in SVD patients. Quantitative T 2 ' values were averaged across the entire white matter (WM). Furthermore, T 2 ' values were extracted from normal-appearing WM (NAWM) and the WMH and compared between patients and controls. RESULTS Quantitative T 2 ' values were significantly increased across the entire WM and in the NAWM in patients compared to control subjects (149.51 ± 16.94 vs. 138.19 ± 12.66 ms and 147.45 ± 18.14 vs. 137.99 ± 12.19 ms, p < 0.05). WM T 2 ' values correlated significantly with the WMH load (ρ=0.441, p = 0.006). Increased T 2 ' was significantly associated with more alkaline pHi (ρ=0.299, p < 0.05). Both T 2 ' and pHi were significantly positively correlated with vascular pulsatility in the distal carotid arteries (ρ=0.596, p = 0.001 and ρ=0.452, p = 0.016). CONCLUSIONS This exploratory study found evidence of impaired cerebral OEF in SVD, which is associated with intracellular alkalosis as an adaptive mechanism. The employed techniques provide new insights into the pathophysiology of SVD with regard to disease-related consequences on the cellular metabolic state.
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Key Words
- BBB, blood-brain barrier
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- CMRO2, Cerebral metabolic rate of oxygen
- Cellular energy metabolism
- DTI, diffusion tensor imaging
- GE, gradient echo
- Hb, hemoglobin
- ICA, internal carotid artery
- MR spectroscopy
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- MRSI, magnetic resonance spectroscopic imaging
- Microstructural impairment
- NAWM, normal-appearing white matter
- OEF, oxygen extraction fraction
- Oxygen extraction fraction
- PI, Pulsatility index
- RF, radio frequency
- SVD, cerebral small vessel disease
- Small vessel disease
- TR, repetition time
- WM, white matter
- WMH, white matter hyperintensities
- pHi, intracellular pH
- quantitative MRI
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Affiliation(s)
- Annemarie Reiländer
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Jan-Rüdiger Schüre
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
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Jiang D, Lu H. Cerebral oxygen extraction fraction MRI: Techniques and applications. Magn Reson Med 2022; 88:575-600. [PMID: 35510696 PMCID: PMC9233013 DOI: 10.1002/mrm.29272] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022]
Abstract
The human brain constitutes 2% of the body's total mass but uses 20% of the oxygen. The rate of the brain's oxygen utilization can be derived from a knowledge of cerebral blood flow and the oxygen extraction fraction (OEF). Therefore, OEF is a key physiological parameter of the brain's function and metabolism. OEF has been suggested to be a useful biomarker in a number of brain diseases. With recent advances in MRI techniques, several MRI-based methods have been developed to measure OEF in the human brain. These MRI OEF techniques are based on the T2 of blood, the blood signal phase, the magnetic susceptibility of blood-containing voxels, the effect of deoxyhemoglobin on signal behavior in extravascular tissue, and the calibration of the BOLD signal using gas inhalation. Compared to 15 O PET, which is considered the "gold standard" for OEF measurement, MRI-based techniques are non-invasive, radiation-free, and are more widely available. This article provides a review of these emerging MRI-based OEF techniques. We first briefly introduce the role of OEF in brain oxygen homeostasis. We then review the methodological aspects of different categories of MRI OEF techniques, including their signal mechanisms, acquisition methods, and data analyses. The strengths and limitations of the techniques are discussed. Finally, we review key applications of these techniques in physiological and pathological conditions.
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Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
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Crespo Pimentel B, Sedlacik J, Schröder J, Heinze M, Østergaard L, Fiehler J, Gerloff C, Thomalla G, Cheng B. Comprehensive Evaluation of Cerebral Hemodynamics and Oxygen Metabolism in Revascularization of Asymptomatic High-Grade Carotid Stenosis. Clin Neuroradiol 2021; 32:163-173. [PMID: 34487195 PMCID: PMC8894147 DOI: 10.1007/s00062-021-01077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
Introduction Revascularization procedures in carotid artery stenosis have shown a positive effect in the restoration of cerebral oxygen metabolism as assessed by T2’ (T2 prime) imaging as well as capillary homeostasis by measurement of capillary transit time heterogeneity (CTH); however, data in patients with asymptomatic carotid stenosis without manifest brain lesions are scarce. Patients and Methods The effect of revascularization on the hemodynamic profile and capillary homeostasis was evaluated in 13 patients with asymptomatic high-grade carotid stenosis without ischemic brain lesions using dynamic susceptibility contrast perfusion imaging and oxygenation-sensitive T2’ mapping before and 6–8 weeks after revascularization by endarterectomy or stenting. The cognitive performance at both timepoints was further assessed. Results Perfusion impairment at baseline was accompanied by an increased CTH (p = 0.008) in areas with a time to peak delay ≥ 2 s in the affected hemisphere compared to contralateral regions. Carotid intervention improved the overall moderate hemodynamic impairment at baseline by leading to an increase in normalized cerebral blood flow (p = 0.017) and a decrease in mean transit time (p = 0.027), oxygen extraction capacity (OEC) (p = 0.033) and CTH (p = 0.048). The T2’ values remained unchanged. Conclusion This study presents novel evidence of a state of altered microvascular function in patients with high-grade carotid artery stenosis in the absence of ischemic brain lesions, which shows sustained normalization after revascularization procedures. Supplementary Information The online version of this article (10.1007/s00062-021-01077-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jan Sedlacik
- Centre for the Developing Brain & Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Julian Schröder
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Heinze
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Seiler A, Kammerer S, Gühl A, Schüre JR, Deichmann R, Nöth U, Pfeilschifter W, Hattingen E, Keese M, Pilatus U, Wagner M. Revascularization of High-Grade Carotid Stenosis Restores Global Cerebral Energy Metabolism. Stroke 2019; 50:1742-1750. [PMID: 31164069 DOI: 10.1161/strokeaha.118.023559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Chronic cerebral hemodynamic impairment due to high-grade occlusive carotid disease may lead to compromised energy metabolism. This might result in chronic subtle tissue damage, even in patients without overt brain infarction. The aim of this study was to investigate hypoperfusion-related changes of cerebral energy metabolism and their potential restitution after revascularization. For this purpose, 3-dimensional 31P magnetic resonance spectroscopy and oxygenation-sensitive T2' magnetic resonance imaging were used (with 1/T2'=1/T2*-1/T2), which were expected to cross-validate each other. Methods- Ten patients with unilateral high-grade carotid artery stenosis resulting in a transient ischemic attack or a nondisabling cerebral ischemia were included. Then, high-energy metabolites, intracellular pH, and oxygenation-sensitive quantitative (q)T2' values were determined in noninfarcted hypoperfused areas delineated on time-to-peak maps from perfusion-weighted imaging and in unaffected contralateral areas before and shortly after carotid stenting/endarterectomy. Repeated measures ANOVA was used to test for intervention effects. Results- Within dependent hypoperfused areas ipsilateral to the stenosis, qT2' was significantly decreased ( P<0.05) as compared to corresponding contralateral areas before carotid intervention. There was a significant effect of carotid intervention on qT2' values in both hemispheres ( P<0.001). No differences between hemispheres were found for qT2' after revascularization. Intracellular pH and qT2' values showed a significant negative relationship ( P=0.005) irrespective of time point and hemisphere. Conclusions- After revascularization of unilateral high-grade carotid stenosis, previously decreased qT2' in the dependent hypoperfused territory as marker of hypoxia reincreases not only in the dependent territory but also in corresponding contralateral brain tissue. This might indicate a restriction of the whole-brain oxygen metabolism in case of unilateral high-grade carotid stenosis and an improvement of whole-brain oxygenation after revascularization that goes beyond acute clinically apparent affection of the dependent territory. Furthermore, tissue oxygen supply seems to be closely linked to intracellular pH.
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Affiliation(s)
- Alexander Seiler
- From the Department of Neurology (A.S., W.P.), Goethe University Frankfurt, Germany
| | - Sara Kammerer
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Alexander Gühl
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Jan Rüdiger Schüre
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center (R.D., U.N.), Goethe University Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center (R.D., U.N.), Goethe University Frankfurt, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Michael Keese
- Department of Vascular Surgery (M.K.), Goethe University Frankfurt, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
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Stone AJ, Harston GWJ, Carone D, Okell TW, Kennedy J, Blockley NP. Prospects for investigating brain oxygenation in acute stroke: Experience with a non-contrast quantitative BOLD based approach. Hum Brain Mapp 2019; 40:2853-2866. [PMID: 30860660 PMCID: PMC6563088 DOI: 10.1002/hbm.24564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Metabolic markers of baseline brain oxygenation and tissue perfusion have an important role to play in the early identification of ischaemic tissue in acute stroke. Although well established MRI techniques exist for mapping brain perfusion, quantitative imaging of brain oxygenation is poorly served. Streamlined-qBOLD (sqBOLD) is a recently developed technique for mapping oxygenation that is well suited to the challenge of investigating acute stroke. In this study a noninvasive serial imaging protocol was implemented, incorporating sqBOLD and arterial spin labelling to map blood oxygenation and perfusion, respectively. The utility of these parameters was investigated using imaging based definitions of tissue outcome (ischaemic core, infarct growth and contralateral tissue). Voxel wise analysis revealed significant differences between all tissue outcomes using pairwise comparisons for the transverse reversible relaxation rate (R 2 '), deoxygenated blood volume (DBV) and deoxyghaemoglobin concentration ([dHb]; p < 0.01 in all cases). At the patient level (n = 9), a significant difference was observed for [dHb] between ischaemic core and contralateral tissue. Furthermore, serial analysis at the patient level (n = 6) revealed significant changes in R 2 ' between the presentation and 1 week scans for both ischaemic core (p < 0.01) and infarct growth (p < 0.05). In conclusion, this study presents evidence supporting the potential of sqBOLD for imaging oxygenation in stroke.
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Affiliation(s)
- Alan J Stone
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - George W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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6
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Mitrović V, Marić R, Filipović-Danić S, Petrović N. Extracranial carotid atherosclerosis in genesis infarction brain in the border zones supratentorial localization. PRAXIS MEDICA 2019. [DOI: 10.5937/pramed1901015m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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7
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Seiler A, Deichmann R, Nöth U, Lauer A, Pfeilschifter W, Singer OC, Wagner M. Extent of Microstructural Tissue Damage Correlates with Hemodynamic Failure in High-Grade Carotid Occlusive Disease: An MRI Study Using Quantitative T2 and DSC Perfusion. AJNR Am J Neuroradiol 2018; 39:1273-1279. [PMID: 29748200 DOI: 10.3174/ajnr.a5666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chronic hemodynamic impairment in high-grade carotid occlusive disease is thought to cause microstructural abnormalities that might be subclinical or lead to subtle symptoms including cognitive impairment. Quantitative MR imaging allows assessing pathologic structural changes beyond macroscopically visible tissue damage. In this study, high-resolution quantitative T2 mapping combined with DSC-based PWI was used to investigate quantitative T2 changes as a potential marker of microstructural damage in relation to hemodynamic impairment in patients with unilateral high-grade carotid occlusive disease. MATERIALS AND METHODS Eighteen patients with unilateral high-grade ICA or MCA stenosis/occlusion were included in the study. T2 values and deconvolved perfusion parameters, including relative CBF, relative CBV, and the relative CBF/relative CBV ratio as a potential indicator of local cerebral perfusion pressure, were determined within areas with delayed TTP and compared with values from contralateral unaffected areas after segmentation of normal-appearing hypoperfused WM and cortical regions. Hemispheric asymmetry indices were calculated for all parameters. RESULTS Quantitative T2 was significantly prolonged (P < .01) in hypoperfused tissue and correlated significantly (P < .01) with TTP delay and relative CBF/relative CBV reduction in WM. Significant correlations (P < .001) between TTP delay and the relative CBF/relative CBV ratio were found both in WM and in cortical areas. CONCLUSIONS Quantitative T2 can be used as a marker of microstructural tissue damage even in normal-appearing GM and WM within a vascular territory affected by high-grade carotid occlusive disease. Furthermore, the extent of damage correlates with the degree of hemodynamic failure measured by DSC perfusion parameters.
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Affiliation(s)
- A Seiler
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | | | - U Nöth
- Brain Imaging Center (R.D., U.N.)
| | - A Lauer
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
| | | | - O C Singer
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | - M Wagner
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
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8
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Mitrović V, Filipović-Danić S. Clinical manifestation in patients with ischemic stroke in the border zone of the middle cerebral artery. PRAXIS MEDICA 2018. [DOI: 10.5937/pramed1804001m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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9
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Jensen-Kondering U, Manavaki R, Ejaz S, Sawiak SJ, Carpenter TA, Fryer TD, Aigbirhio FI, Williamson DJ, Baron JC. Brain hypoxia mapping in acute stroke: Back-to-back T2' MR versus 18F-fluoromisonidazole PET in rodents. Int J Stroke 2017; 12:752-760. [PMID: 28523963 DOI: 10.1177/1747493017706221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Mapping the hypoxic brain in acute ischemic stroke has considerable potential for both diagnosis and treatment monitoring. PET using 18F-fluoro-misonidazole (FMISO) is the reference method; however, it lacks clinical accessibility and involves radiation exposure. MR-based T2' mapping may identify tissue hypoxia and holds clinical potential. However, its validation against FMISO imaging is lacking. Here we implemented back-to-back FMISO-PET and T2' MR in rodents subjected to acute middle cerebral artery occlusion. For direct clinical relevance, regions of interest delineating reduced T2' signal areas were manually drawn. Methods Wistar rats were subjected to filament middle cerebral artery occlusion, immediately followed by intravenous FMISO injection. Multi-echo T2 and T2* sequences were acquired twice during FMISO brain uptake, interleaved with diffusion-weighted imaging. Perfusion-weighted MR was also acquired whenever feasible. Immediately following MR, PET data reflecting the history of FMISO brain uptake during MR acquisition were acquired. T2' maps were generated voxel-wise from T2 and T2*. Two raters independently drew T2' lesion regions of interest. FMISO uptake and perfusion data were obtained within T2' consensus regions of interest, and their overlap with the automatically generated FMISO lesion and apparent diffusion coefficient lesion regions of interest was computed. Results As predicted, consensus T2' lesion regions of interest exhibited high FMISO uptake as well as substantial overlap with the FMISO lesion and significant hypoperfusion, but only small overlap with the apparent diffusion coefficient lesion. Overlap of the T2' lesion regions of interest between the two raters was ∼50%. Conclusions This study provides formal validation of T2' to map non-core hypoxic tissue in acute stroke. T2' lesion delineation reproducibility was suboptimal, reflecting unclear lesion borders.
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Affiliation(s)
- Ulf Jensen-Kondering
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,3 Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Roido Manavaki
- 4 Department of Radiology, University of Cambridge, Cambridge, UK
| | - Sohail Ejaz
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Stephen J Sawiak
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - T Adrian Carpenter
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David J Williamson
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jean-Claude Baron
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,5 INSERM U894, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
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Ava L, Berkefeld J, Lauer A, Seiler A, Pfeilschifter W, Müller-Eschner M, You SJ, Weidauer S, Pilatus U, Wagner M. Predictive Value of Pooled Cerebral Blood Volume Mapping for Final Infarct Volume in Patients with Major Artery Occlusions. A Retrospective Analysis. Clin Neuroradiol 2017; 27:435-442. [DOI: 10.1007/s00062-017-0569-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
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Seiler A, Deichmann R, Pfeilschifter W, Hattingen E, Singer OC, Wagner M. T2-Imaging to Assess Cerebral Oxygen Extraction Fraction in Carotid Occlusive Disease: Influence of Cerebral Autoregulation and Cerebral Blood Volume. PLoS One 2016; 11:e0161408. [PMID: 27560515 PMCID: PMC4999181 DOI: 10.1371/journal.pone.0161408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Quantitative T2'-mapping detects regional changes of the relation of oxygenated and deoxygenated hemoglobin (Hb) by using their different magnetic properties in gradient echo imaging and might therefore be a surrogate marker of increased oxygen extraction fraction (OEF) in cerebral hypoperfusion. Since elevations of cerebral blood volume (CBV) with consecutive accumulation of Hb might also increase the fraction of deoxygenated Hb and, through this, decrease the T2'-values in these patients we evaluated the relationship between T2'-values and CBV in patients with unilateral high-grade large-artery stenosis. MATERIALS AND METHODS Data from 16 patients (13 male, 3 female; mean age 53 years) with unilateral symptomatic or asymptomatic high-grade internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis/occlusion were analyzed. MRI included perfusion-weighted imaging and high-resolution T2'-mapping. Representative relative (r)CBV-values were analyzed in areas of decreased T2' with different degrees of perfusion delay and compared to corresponding contralateral areas. RESULTS No significant elevations in cerebral rCBV were detected within areas with significantly decreased T2'-values. In contrast, rCBV was significantly decreased (p<0.05) in regions with severe perfusion delay and decreased T2'. Furthermore, no significant correlation between T2'- and rCBV-values was found. CONCLUSIONS rCBV is not significantly increased in areas of decreased T2' and in areas of restricted perfusion in patients with unilateral high-grade stenosis. Therefore, T2' should only be influenced by changes of oxygen metabolism, regarding our patient collective especially by an increase of the OEF. T2'-mapping is suitable to detect altered oxygen consumption in chronic cerebrovascular disease.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- * E-mail:
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Elke Hattingen
- Department of Neuroradiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Oliver C. Singer
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Department of Neurology, Helios HSK Hospital, Wiesbaden, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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12
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Quantitative T2* mapping reveals early temporo-spatial dynamics in an ischemic stroke model. J Neurosci Methods 2016; 259:83-89. [DOI: 10.1016/j.jneumeth.2015.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/18/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022]
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13
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Quantitative T2, T2*, and T2' MR imaging in patients with ischemic leukoaraiosis might detect microstructural changes and cortical hypoxia. Neuroradiology 2015; 57:1023-30. [PMID: 26227168 DOI: 10.1007/s00234-015-1565-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/13/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Quantitative MRI with T2, T2*, and T2' mapping has been shown to non-invasively depict microstructural changes (T2) and oxygenation status (T2* and T2') that are invisible on conventional MRI. Therefore, we aimed to assess whether T2 and T2' quantification detects cerebral (micro-)structural damage and chronic hypoxia in lesions and in normal appearing white matter (WM) and gray matter (GM) of patients with ischemic leukoaraiosis (IL). Measurements were complemented by the assessment of the cerebral blood flow (CBF) and the degree of GM and WM atrophy. METHODS Eighteen patients with IL and 18 age-matched healthy controls were included. High-resolution, motion-corrected T2, T2*, and T2' mapping, CBF mapping (pulsed arterial spin labeling, PASL), and segmentation of GM and WM were used to depict specific changes in both groups. All parameters were compared between patients and healthy controls, using t testing. Values of p < 0.05 were accepted as statistically significant. RESULTS Patients showed significantly increased T2 in lesions (p < 0.01) and in unaffected WM (p = 0.045) as well as significantly increased T2* in lesions (p = 0.003). A significant decrease of T2' was detected in patients in unaffected WM (p = 0.027), while no T2' changes were observed in GM (p = 0.13). Both unaffected WM and GM were significantly decreased in volume in the patient-group (p < 0.01). No differences of PASL-based CBF could be shown. CONCLUSION Non-invasive quantitative MRI with T2, T2*, and T2' mapping might be used to detect subtle structural and metabolic changes in IL. Assessing the grade of microstructural damage and hypoxia might be helpful to monitor disease progression and to perform risk assessment.
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Bouvier J, Detante O, Tahon F, Attye A, Perret T, Chechin D, Barbieux M, Boubagra K, Garambois K, Tropres I, Grand S, Barbier EL, Krainik A. Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study. Hum Brain Mapp 2014; 36:695-706. [PMID: 25307948 DOI: 10.1002/hbm.22657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
Multiparametric quantitative blood oxygenation level dependent (mqBOLD) magnetic resonance Imaging (MRI) approach allows mapping tissular oxygen saturation (StO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). To identify hemodynamic alteration related to severe intracranial arterial stenosis (SIAS), functional MRI of cerebrovascular reserve (CVR BOLD fMRI) to hypercapnia has been proposed. Diffusion imaging suggests chronic low grade ischemia in patients with impaired CVR. The aim of the present study was to evaluate how oxygen parameters (StO2 and CMRO2 ), assessed with mqBOLD approach, correlate with CVR in patients (n = 12) with SIAS and without arterial occlusion. The perfusion (dynamic susceptibility contrast), oxygenation, and CVR were compared. The MRI protocol conducted at 3T lasted approximately 1 h. Regions of interest measures on maps were delineated on segmented gray matter (GM) of middle cerebral artery territories. We have shown that decreased CVR is spatially associated with decreased CMRO2 in GM of patients with SIAS. Further, the degree of ipsilateral CVR reduction was well-correlated with the amplitude of the CMRO2 deficit. The altered CMRO2 suggests the presence of a moderate ischemia explained by both a decrease in perfusion and in CVR. CVR and mqBOLD method may be helpful in the selection of patients with SIAS to advocate for medical therapy or percutaneous transluminal angioplasty-stenting.
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Affiliation(s)
- Julien Bouvier
- Inserm, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France; Philips France (Healthcare Activity), Suresnes, France
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15
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Bauer S, Wagner M, Seiler A, Hattingen E, Deichmann R, Nöth U, Singer OC. Quantitative T2'-mapping in acute ischemic stroke. Stroke 2014; 45:3280-6. [PMID: 25278559 DOI: 10.1161/strokeaha.114.006530] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Quantitative T2'-mapping detects regional changes in the relation of oxygenated and deoxygenated haemoglobine and might reflect areas with increased oxygen extraction. T2'-mapping in conjunction with an elaborate algorithm for motion correction was performed in patients with acute large-vessel stroke, and quantitative T2'-values were determined within the diffusion-weighted imaging lesion and perfusion-restricted tissue. METHODS Eleven patients (median age, 71 years) with acute middle cerebral or internal carotid artery occlusion underwent MRI before scheduled endovascular treatment. MR-examination included diffusion- and perfusion-weighted imaging and quantitative, motion-corrected mapping of T2'. Time-to-peak maps were thresholded for different degrees of perfusion delays (eg, ≥0 s, ≥ 2s) when compared with a reference time-to-peak value from healthy contralateral tissue. Mean T2'-values in areas with reduced apparent diffusion coefficient and in areas with impaired perfusion were compared with T2'-values in corresponding contralateral areas. RESULTS Median time between symptom onset and MRI was 238 minutes. T2'-values were significantly reduced within the apparent diffusion coefficient -lesion when compared with contralateral healthy tissue (83 ms [67, 97] versus 97 ms [91, 111]; P<0.003). In perfusion-restricted tissue, T2'-values were also significantly lower when compared with contralateral healthy tissue (ie, for time to peak, ≥0 s 93 ms [86, 102] versus 104 [90, 110]; P=0.008) but were significantly higher than within the apparent diffusion coefficient lesion. The severity of the perfusion impairment had no influence on median T2'-values. CONCLUSIONS Motion-corrected T2'-mapping reveals significant and gradually declining values from healthy to perfusion-disturbed to apparent diffusion coefficient-restricted tissue. Current T2'-mapping can differentiate between the ischemic core and the perfusion-impaired areas but not on its own between penumbral and oligemic tissue.
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Affiliation(s)
- Sonja Bauer
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Marlies Wagner
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Alexander Seiler
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ralf Deichmann
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ulrike Nöth
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Oliver C Singer
- From the Department of Neurology (S.B., A.S., O.C.S.), Institute for Neuroradiology (M.W., E.H.); and Brain Imaging Center (R.D., U.N.), University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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16
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RIEGER JOHANNES, BÄHR OLIVER, MAURER GABRIELED, HATTINGEN ELKE, FRANZ KEA, BRUCKER DANIEL, WALENTA STEFAN, KÄMMERER ULRIKE, COY JOHANNESF, WELLER MICHAEL, STEINBACH JOACHIMP. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int J Oncol 2014; 44:1843-52. [PMID: 24728273 PMCID: PMC4063533 DOI: 10.3892/ijo.2014.2382] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/11/2014] [Indexed: 12/19/2022] Open
Abstract
Limiting dietary carbohydrates inhibits glioma growth in preclinical models. Therefore, the ERGO trial (NCT00575146) examined feasibility of a ketogenic diet in 20 patients with recurrent glioblastoma. Patients were put on a low-carbohydrate, ketogenic diet containing plant oils. Feasibility was the primary endpoint, secondary endpoints included the percentage of patients reaching urinary ketosis, progression-free survival (PFS) and overall survival. The effects of a ketogenic diet alone or in combination with bevacizumab was also explored in an orthotopic U87MG glioblastoma model in nude mice. Three patients (15%) discontinued the diet for poor tolerability. No serious adverse events attributed to the diet were observed. Urine ketosis was achieved at least once in 12 of 13 (92%) evaluable patients. One patient achieved a minor response and two patients had stable disease after 6 weeks. Median PFS of all patients was 5 (range, 3-13) weeks, median survival from enrollment was 32 weeks. The trial allowed to continue the diet beyond progression. Six of 7 (86%) patients treated with bevacizumab and diet experienced an objective response, and median PFS on bevacizumab was 20.1 (range, 12-124) weeks, for a PFS at 6 months of 43%. In the mouse glioma model, ketogenic diet alone had no effect on median survival, but increased that of bevacizumab-treated mice from 52 to 58 days (p<0.05). In conclusion, a ketogenic diet is feasible and safe but probably has no significant clinical activity when used as single agent in recurrent glioma. Further clinical trials are necessary to clarify whether calorie restriction or the combination with other therapeutic modalities, such as radiotherapy or anti-angiogenic treatments, could enhance the efficacy of the ketogenic diet.
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Affiliation(s)
- JOHANNES RIEGER
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, D-60528 Frankfurt
- Department of Neurology, University Hospital Tübingen, D-72076 Tübingen,
Germany
| | - OLIVER BÄHR
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, D-60528 Frankfurt
| | - GABRIELE D. MAURER
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, D-60528 Frankfurt
| | - ELKE HATTINGEN
- Institute of Neuroradiology, University Hospital Frankfurt, D-60528 Frankfurt
| | - KEA FRANZ
- Department for Neurosurgery, University Hospital Frankfurt, D-60528 Frankfurt
| | - DANIEL BRUCKER
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, D-60528 Frankfurt
| | - STEFAN WALENTA
- Institute of Physiology and Pathophysiology, Johannes Gutenberg-University, D-55099 Mainz
| | - ULRIKE KÄMMERER
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, D-97080 Würzburg
| | - JOHANNES F. COY
- Tavarlin AG, D-64293 Darmstadt, University Hospital Tübingen, D-72076 Tübingen,
Germany
| | - MICHAEL WELLER
- Department of Neurology, University Hospital Tübingen, D-72076 Tübingen,
Germany
- Department of Neurology, University Hospital Zurich, 8091 Zurich,
Switzerland
| | - JOACHIM P. STEINBACH
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, D-60528 Frankfurt
- Department of Neurology, University Hospital Tübingen, D-72076 Tübingen,
Germany
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Yamauchi H, Higashi T, Kagawa S, Kishibe Y, Takahashi M. Chronic hemodynamic compromise and cerebral ischemic events in asymptomatic or remote symptomatic large-artery intracranial occlusive disease. AJNR Am J Neuroradiol 2013; 34:1704-10. [PMID: 23471022 DOI: 10.3174/ajnr.a3491] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In asymptomatic or remote symptomatic LAICOD, the risk of ischemic events is low in general, but there may be a subgroup of higher risk patients who require aggressive medical management. The purpose of this study was to determine whether chronic hemodynamic compromise is a predictor of ischemic events in asymptomatic or remote symptomatic LAICOD. MATERIALS AND METHODS We prospectively studied 51 asymptomatic, 19 coexistent asymptomatic, and 19 remote (>6 months) symptomatic patients with atherosclerotic intracranial internal carotid artery or middle cerebral artery disease by using (15)O-PET. MP was defined as decreased CBF, increased OEF, and a decreased CBF/CBV ratio. All patients were followed up for 2 years or until occurrence of stroke or TIA or death. RESULTS Bypass surgery was performed in 4 patients (2 with MP). Three cerebral ischemic events (1 TIA in an asymptomatic patient, 1 stroke, and 1 TIA in a remote symptomatic patient) occurred in the vascular territory ipsilateral to LAICOD. Kaplan-Meier analysis with censoring at the time of bypass surgery revealed that the incidence of ipsilateral ischemic events in patients with MP (2/5) was significantly higher than that in patients without MP (1/84) (log-rank test; P < .0001). The relative risk conferred by MP was 83.1 (95% confidence interval, 6.8-1017.4; P < .001). The incidence of ipsilateral ischemic events in patients with decreased CBF/CBV (2/9) was also significantly higher than that of patients without it (1/80) (P = .0001). CONCLUSIONS Chronic hemodynamic compromise may be a predictor of ischemic events in both asymptomatic and remote symptomatic LAICOD.
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Affiliation(s)
- H Yamauchi
- Division of PET Imaging, Shiga Medical Center Research Institute, Shiga, Japan
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18
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Does preinterventional flat-panel computer tomography pooled blood volume mapping predict final infarct volume after mechanical thrombectomy in acute cerebral artery occlusion? Cardiovasc Intervent Radiol 2013; 36:1132-8. [PMID: 23435740 DOI: 10.1007/s00270-013-0574-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Decreased cerebral blood volume is known to be a predictor for final infarct volume in acute cerebral artery occlusion. To evaluate the predictability of final infarct volume in patients with acute occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA) and successful endovascular recanalization, pooled blood volume (PBV) was measured using flat-panel detector computed tomography (FPD CT). MATERIALS AND METHODS Twenty patients with acute unilateral occlusion of the MCA or distal ACI without demarcated infarction, as proven by CT at admission, and successful Thrombolysis in cerebral infarction score (TICI 2b or 3) endovascular thrombectomy were included. Cerebral PBV maps were acquired from each patient immediately before endovascular thrombectomy. Twenty-four hours after recanalization, each patient underwent multislice CT to visualize final infarct volume. Extent of the areas of decreased PBV was compared with the final infarct volume proven by follow-up CT the next day. RESULTS In 15 of 20 patients, areas of distinct PBV decrease corresponded to final infarct volume. In 5 patients, areas of decreased PBV overestimated final extension of ischemia probably due to inappropriate timing of data acquisition and misery perfusion. CONCLUSION PBV mapping using FPD CT is a promising tool to predict areas of irrecoverable brain parenchyma in acute thromboembolic stroke. Further validation is necessary before routine use for decision making for interventional thrombectomy.
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