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The association between neurological deficit in acute ischemic stroke and mean transit time

Comparison of four different perfusion MRI algorithms

  • Diagnostic Neuroradiology
  • Published:
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Abstract

The purpose of our study was to identify the perfusion MRI (pMRI) algorithm which yields a volume of hypoperfused tissue that best correlates with the acute clinical deficit as quantified by the NIH Stroke Scale (NIHSS) and therefore reflects critically hypoperfused tissue. A group of 20 patients with a first acute stroke and stroke MRI within 24 h of symptom onset were retrospectively analyzed. Perfusion maps were derived using four different algorithms to estimate relative mean transit time (rMTT): (1) cerebral blood flow (CBF) arterial input function (AIF)/singular voxel decomposition (SVD); (2) area peak; (3) time to peak (TTP); and (4) first moment method. Lesion volumes based on five different MTT thresholds relative to contralateral brain were compared with each other and correlated with NIHSS score. The first moment method had the highest correlation with NIHSS (r=0.79, P<0.001) followed by the AIF/SVD method, both of which did not differ significantly from each other with regard to lesion volumes. TTP and area peak derived both volumes, which correlated poorly or only moderately with NIHSS scores. Data from our pilot study suggest that the first moment and the AIF/SVD method have advantages over the other algorithms in identifying the pMRI lesion volume that best reflects clinical severity. At present there seems to be no need for extensive postprocessing and arbitrarily defined delay thresholds in pMRI as the simple qualitative approach with a first moment algorithm is equally accurate. Larger sample sizes which allow comparison between imaging and clinical outcomes are needed to refine the choice of best perfusion parameter in pMRI.

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References

  1. Schellinger PD, Fiebach JB, Hacke W (2003) Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status. Stroke 34(2):575–583

    Article  PubMed  Google Scholar 

  2. Warach S, Dashe JF, Edelman RR (1996) Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab 16(1):53–59

    Article  PubMed  CAS  Google Scholar 

  3. Beaulieu C, de Crespigny A, Tong DC, et al (1999) Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: evolution of lesion volume and correlation with clinical outcome. Ann Neurol 46(4):568–578

    Article  PubMed  CAS  Google Scholar 

  4. Schellinger PD, Fiebach JB, Jansen O, et al (2001) Stroke magnetic resonance imaging within 6 hours after onset of hyperacute cerebral ischemia. Ann Neurol 49(4):460–469

    Article  PubMed  CAS  Google Scholar 

  5. Warach S, Pettigrew LC, Dashe JF, et al (2000) Effect of citicoline on ischemic lesions as measured by diffusion-weighted magnetic resonance imaging. Citicoline 010 Investigators. Ann Neurol 48(5):713–722

    Article  PubMed  CAS  Google Scholar 

  6. Röther J, Schellinger PD, Gass A, et al (2002) Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 h. Stroke 33(10):2438–2445

    Article  PubMed  Google Scholar 

  7. Kidwell CS, Saver JL, Mattiello J, et al (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47(4):462–469

    Article  PubMed  CAS  Google Scholar 

  8. Fiehler J, Foth M, Kucinski T, et al (2002) Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke 33(1):79–86

    Article  PubMed  Google Scholar 

  9. Warach S (2001) Tissue viability thresholds in acute stroke: the 4-factor model. Stroke 32(11):2460–2461

    PubMed  CAS  Google Scholar 

  10. Grandin CB, Duprez TP, Smith AM, et al (2002) Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology 223(2):361–370

    Article  PubMed  Google Scholar 

  11. Yamada K, Wu O, Gonzalez RG, et al (2002) Magnetic resonance perfusion-weighted imaging of acute cerebral infarction: effect of the calculation methods and underlying vasculopathy. Stroke 33(1):87–94

    Article  PubMed  Google Scholar 

  12. Neumann-Haefelin T, Wittsack HJ, Wenserski F, et al (1999) Diffusion and perfusion weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke 30:1591–1597

    PubMed  CAS  Google Scholar 

  13. Butcher K, Parsons M, Baird T, et al (2003) Perfusion thresholds in acute stroke thrombolysis. Stroke 34(9):2159–2164

    Article  PubMed  CAS  Google Scholar 

  14. Rosen BR, Belliveau JW, Vevea JM, Brady TJ (1990) Perfusion imaging with NMR contrast agents. Magn Reson Med 14:249–265

    Article  PubMed  CAS  Google Scholar 

  15. Schlaug G, Benfield A, Baird AE, et al (1999) The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 53(7):1528–1537

    PubMed  CAS  Google Scholar 

  16. Ostergaard L, Weisskoff RM, Chesler DA, Gyldensted C, Rosen BR (1996) High resolution measurement of cerebral blood flow using intravascular tracer bolus passages, part I: mathematical approach and statistical analysis. Magn Reson Med 36:715–725

    Article  PubMed  CAS  Google Scholar 

  17. Heiland S, Benner T, Reith W, Forsting M, Sartor K (1997) Perfusion-weighted MRI using gadobutrol as a contrast agent in a rat stroke model. J Magn Reson Imaging 7(6):1109–1115

    Article  PubMed  CAS  Google Scholar 

  18. Kidwell CS, Alger JR, Saver JL (2003) Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke 34(11):2729–2735

    Article  PubMed  Google Scholar 

  19. Wu O, Ostergaard L, Koroshetz WJ, et al (2003) Effects of tracer arrival time on flow estimates in MR perfusion-weighted imaging. Magn Reson Med 50(4):856–864

    Article  PubMed  Google Scholar 

  20. Calamante F, Gadian DG, Connelly A (2002) Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 33(4):1146–1151

    Article  PubMed  CAS  Google Scholar 

  21. Sorensen AG (2001) What is the meaning of quantitative CBF? AJNR Am J Neuroradiol 22:235–236

    PubMed  CAS  Google Scholar 

  22. Warach S (2003) Measurement of the ischemic penumbra with MRI: it's about time. Stroke 34(10):2533–2534

    Article  PubMed  Google Scholar 

  23. Lyden P, Brott T, Tilley B, et al (1994) Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke 25(11):2220–2226

    PubMed  CAS  Google Scholar 

  24. Neumann-Haefelin T, Wittsack HJ, Fink GR, et al (2000) Diffusion- and perfusion-weighted MRI—influence of severe carotid artery stenosis on the DWI/PWI mismatch in acute stroke. Stroke 31(6):1311–1317

    PubMed  CAS  Google Scholar 

  25. Hillis AE, Wityk RJ, Barker PB, Ulatowski JA, Jacobs MA (2003) Change in perfusion in acute nondominant hemisphere stroke may be better estimated by tests of hemispatial neglect than by the National Institutes of Health Stroke Scale. Stroke 34(10):2392–2396

    Article  PubMed  Google Scholar 

  26. Schellinger PD, Jansen O, Fiebach JB, et al (2000) Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia. AJNR Am J Neuroradiol 21(7):1184–1189

    PubMed  CAS  Google Scholar 

  27. Berrouschot J, Barthel H, Hesse S, et al (2000) Reperfusion and metabolic recovery of brain tissue and clinical outcome after ischemic stroke and thrombolytic therapy. Stroke 31(7):1545–1551

    PubMed  CAS  Google Scholar 

  28. Warach S (2004) Early reperfusion related to clinical response in DIAS—Phase II, randomized, placebo-controlled dose finding trial of IV desmoteplase 3–9 hours from onset in patients with diffusion–perfusion mismatch. ASA International Stroke Conference, San Diego, CA

  29. Dunn B, Davis L, Todd J, Chalela J, Warach S (2004) Safety of combined abciximab and reteplase in acute ischemic stroke: interim results of ReoPro Retavase Reperfusion of Stroke Safety Study Imaging Evaluation (ROSIE). Annual Meeting of the American Academy of Neurology, San Francisco, CA

  30. Stroke (2003) Major ongoing stroke trials. Stroke 34(6):e61–e72

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Acknowledgements

Jeff Solomon, PhD, of Sensor Systems, Inc. provided invaluable technical support for MedX operations and wrote the macro program that allowed volume analysis by varying degrees of rMTT delay. Drs. Gregory Samsa and Larry Goldstein of Duke Medical School helped refine the interpretation of results by suggesting some of the statistical tests used in this study. This work was in part performed for a research thesis required for graduation from Duke Medical School (Chen-Sen Wu). Patient data were collected with the assistance of members of the Division of Cerebrovascular Diseases at Beth Israel-Deaconess Medical Center in Boston, Massachusetts, USA, during the years 1997–1999. There are no conflicts of interest.

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Authors and Affiliations

  1. Section on Stroke Diagnostics and Therapeutics, NINDS, NIH, Bethesda, MA, 20892, USA

    Peter D. Schellinger, Lawrence L. Latour, Chen-Sen Wu, Julio A. Chalela & Steven Warach

  2. Department of Neurology, University of Heidelberg, Kopfklinik, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Peter D. Schellinger

  3. Duke University School of Medicine, Durham, NC, 27708, USA

    Chen-Sen Wu

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  1. Peter D. Schellinger
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  2. Lawrence L. Latour
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  3. Chen-Sen Wu
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  4. Julio A. Chalela
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  5. Steven Warach
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Correspondence to Peter D. Schellinger.

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Schellinger, P.D., Latour, L.L., Wu, CS. et al. The association between neurological deficit in acute ischemic stroke and mean transit time. Neuroradiology 48, 69–77 (2006). https://doi.org/10.1007/s00234-005-0012-9

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  • DOI: https://doi.org/10.1007/s00234-005-0012-9

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