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Oxygen Challenge Imaging Reveals Differences in Metabolic Activity Between Kurtosis Lesion and Diffusion/Kurtosis Lesion Mismatch in a Rodent Model of Acute Stroke. J Comput Assist Tomogr 2022; 46:792-799. [PMID: 36103679 DOI: 10.1097/rct.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Accurate identification of potentially salvageable tissues is critical for improving acute stroke treatment. A previous study showed that the kurtosis lesion exhibited insignificant response after prompt reperfusion treatment, while the diffusion/kurtosis lesion mismatch could recover after reperfusion. We hypothesized that these 2 regions are in different metabolic states. MATERIALS AND METHODS Transient oxygen challenge (OC) is a procedure that uses oxygen as a metabolic bio-tracer and has been performed to explore metabolic activity in tissues. We combined OC with multiparameter magnetic resonance imaging (including diffusion kurtosis imaging and T2* mapping sequences) to study metabolic activity in the ischemic brain of Sprague Dawley rats. RESULTS Oxygen challenge image analysis revealed changes in T2* values, most significantly in the mean diffusivity (MD)/mean kurtosis (MK) lesion mismatch (22.3 ± 1.6%) and least significantly in the MK lesions (6.6 ± 0.6%). The MD images acquired within 138 ± 9 minutes after ischemia showed a larger ischemic lesion (45.5 ± 3.0% of the total area) than the MK images (33.2 ± 4.2% of the total area). The change rate of the MK value (53.0 ± 4.4%) was higher than that of the MD value (37.5 ± 3.2%). CONCLUSIONS The present study shows that MK lesion and MD/MK lesion mismatch exhibited different metabolic activity states. The MK lesion presented metabolic-related values close to the ischemic core, while at least part of the MD/MK mismatch area was comparable with ischemic penumbra metabolic activity. These findings are important to support image-guided individualized stroke therapies.
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Lu J, Mei Q, Hou X, Manaenko A, Zhou L, Liebeskind DS, Zhang JH, Li Y, Hu Q. Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers. Front Neurol 2021; 12:697779. [PMID: 34630278 PMCID: PMC8497192 DOI: 10.3389/fneur.2021.697779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 12/27/2022] Open
Abstract
In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 and DAWN trials, respectively. Recent guidelines recommend the use of imaging techniques to guide therapeutic decision-making and expanded eligibility in acute ischemic stroke. A tissue window is proposed to replace the time window and serve as the surrogate marker for potentially salvageable tissue. This article reviews the evolution of time window, addresses the advantage of a tissue window in precision medicine for ischemic stroke, and discusses both the established and emerging techniques of neuroimaging and their roles in defining a tissue window. We also emphasize the metabolic imaging and molecular imaging of brain pathophysiology, and highlight its potential in patient selection and treatment response prediction in ischemic stroke.
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Affiliation(s)
- Jianfei Lu
- Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiyong Mei
- Department of Neurosurgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Xianhua Hou
- Department of Neurology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Anatol Manaenko
- National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Zhou
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Hu
- Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Griton M, Dhaya I, Nicolas R, Raffard G, Periot O, Hiba B, Konsman JP. Experimental sepsis-associated encephalopathy is accompanied by altered cerebral blood perfusion and water diffusion and related to changes in cyclooxygenase-2 expression and glial cell morphology but not to blood-brain barrier breakdown. Brain Behav Immun 2020; 83:200-213. [PMID: 31622656 DOI: 10.1016/j.bbi.2019.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) refers to brain dysfunction, including delirium, occurs during severe infection and is associated with development of post-traumatic stress disorder. SAE has been proposed to be related to reduced cerebral blood flow (CBF), blood-brain barrier breakdown (BBB), white matter edema and disruption and glia cell activation, but their exact relationships remain to be determined. In the present work, we set out to study CBF using Arterial Spin Labeling (ASL) and grey and white matter structure with T2- and diffusion magnetic resonance imaging (dMRI) in rats with cecal ligation and puncture (CLP)-induced encephalopathy. Using immunohistochemistry, the distribution of the vasoactive prostaglandin-synthesizing enzyme cyclooxygenase-2 (COX-2), perivascular immunoglobulins G (IgG), aquaporin-4 (AQP4) and the morphology of glial cell were subsequently assessed in brains of the same animals. CLP induced deficits in the righting reflex and resulted in higher T2-weighted contrast intensities in the cortex, striatum and at the base of the brain, decreased blood perfusion distribution to the cortex and increased water diffusion parallel to the fibers of the corpus callosum compared to sham surgery. In addition, CLP reduced staining for microglia- and astrocytic-specific proteins in the corpus callosum, decreased neuronal COX-2 and AQP4 expression in the cortex while inducing perivascular COX-2 expression, but did not induce widespread perivascular IgG diffusion. In conclusion, our findings indicate that experimental SAE can occur in the absence of BBB breakdown and is accompanied by increased water diffusion anisotropy and altered glia cell morphology in brain white matter.
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Affiliation(s)
- Marion Griton
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Service de Réanimation Anesthésie Neurochirurgicale, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Ibtihel Dhaya
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Laboratoire de Neurophysiologie Fonctionnelle et Pathologies, UR/11ES09, Faculté des Sciences Mathématiques, Physiques et Naturelles, Université de Tunis El Manar, Tunis, Tunisia
| | - Renaud Nicolas
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France
| | - Gérard Raffard
- CNRS, Résonance Magnétique des Systèmes Biologiques, UMR 5536, Bordeaux, France; Univ. Bordeaux, RMSB, UMR 5536, Bordeaux, France
| | - Olivier Periot
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Service de Médecine Nucléaire, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Bassem Hiba
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; CNRS UMR 5229, Centre de Neurosciences Cognitives Marc Jeannerod, Bron, France
| | - Jan Pieter Konsman
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France.
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Castaneda Vega S, Weinl C, Calaminus C, Wang L, Harant M, Ehrlichmann W, Thiele D, Kohlhofer U, Reischl G, Hempel JM, Ernemann U, Quintanilla Martinez L, Nordheim A, Pichler BJ. Characterization of a novel murine model for spontaneous hemorrhagic stroke using in vivo PET and MR multiparametric imaging. Neuroimage 2017; 155:245-256. [DOI: 10.1016/j.neuroimage.2017.04.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/29/2017] [Accepted: 04/29/2017] [Indexed: 01/07/2023] Open
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Guo Y, Zhou IY, Chan ST, Wang Y, Mandeville ET, Igarashi T, Lo EH, Ji X, Sun PZ. pH-sensitive MRI demarcates graded tissue acidification during acute stroke - pH specificity enhancement with magnetization transfer and relaxation-normalized amide proton transfer (APT) MRI. Neuroimage 2016; 141:242-249. [PMID: 27444569 DOI: 10.1016/j.neuroimage.2016.07.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022] Open
Abstract
pH-sensitive amide proton transfer (APT) MRI provides a surrogate metabolic biomarker that complements the widely-used perfusion and diffusion imaging. However, the endogenous APT MRI is often calculated using the asymmetry analysis (MTRasym), which is susceptible to an inhomogeneous shift due to concomitant semisolid magnetization transfer (MT) and nuclear overhauser (NOE) effects. Although the intact brain tissue has little pH variation, white and gray matter appears distinct in the MTRasym image. Herein we showed that the heterogeneous MTRasym shift not related to pH highly correlates with MT ratio (MTR) and longitudinal relaxation rate (R1w), which can be reasonably corrected using the multiple regression analysis. Because there are relatively small MT and R1w changes during acute stroke, we postulate that magnetization transfer and relaxation-normalized APT (MRAPT) analysis increases MRI specificity to acidosis over the routine MTRasym image, hence facilitates ischemic lesion segmentation. We found significant differences in perfusion, pH and diffusion lesion volumes (P<0.001, ANOVA). Furthermore, MRAPT MRI depicted graded ischemic acidosis, with the most severe acidosis in the diffusion lesion (-1.05±0.29%/s), moderate acidification within the pH/diffusion mismatch (i.e., metabolic penumbra, -0.67±0.27%/s) and little pH change in the perfusion/pH mismatch (i.e., benign oligemia, -0.04±0.14%/s), providing refined stratification of ischemic tissue injury.
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Affiliation(s)
- Yingkun Guo
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Iris Yuwen Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Yu Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; China-America Joint Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Emiri T Mandeville
- Neuroprotection Research Laboratory, Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Takahiro Igarashi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Eng H Lo
- Neuroprotection Research Laboratory, Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Xunming Ji
- China-America Joint Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; China-America Joint Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China; Neuroprotection Research Laboratory, Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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Affiliation(s)
- Christopher McCabe
- Institute of Neuroscience & Psychology, College of Medical, Veterinary & Life Sciences, Wellcome Surgical Institute, University of Glasgow, Glasgow, UK
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