BACKGROUND AND PURPOSE: Perfusion-weighted imaging maps are used to identify hypoperfusion in acute ischemic stroke. We evaluated maps of cerebral blood flow (CBF), cerebral blood volume, mean transit time, and time to peak (TTP) in acute stroke by comparison with positron emission tomography. METHODS: Perfusion-weighted imaging and positron emission tomography were performed in 26 patients with acute ischemic stroke (median 18.5 hours after stroke onset, 65 minutes between MRI and positron emission tomography). The perfusion-weighted imaging-derived maps of CBF, cerebral blood volume, mean transit time, and TTP delay were compared with quantitative positron emission tomography CBF. A receiver-operating characteristic curve analysis identified the best perfusion-weighted imaging map and threshold to identify hypoperfusion <20 mL/100 g/min, a widely used measure of penumbral flow. RESULTS: Individual regression analysis of positron emission tomography CBF and perfusion-weighted imaging values were strong for CBF and TTP delay and weaker for mean transit time and cerebral blood volume, but the pooled analysis showed a large variance. Receiver-operating characteristic curve analysis identified TTP and CBF maps as most predictive (median area under the curve=0.94 and 0.93). Penumbral flow thresholds were <21.7 mL/100 g/min (CBF), <1.5 mL/100 g (cerebral blood volume), >5.3 seconds (mean transit time), and >4.2 seconds (TTP). TTP and CBF maps reached sensitivity/specificity values of 91%/82% and 89%/87%. CONCLUSIONS: In our sample, maps of CBF, TTP, and mean transit time yielded a good estimate of penumbral flow. The performance of TTP maps was equivalent to deconvolution techniques using an arterial input function. For all maps, the application of a predefined threshold is mandatory and calibration studies will enhance their use in acute stroke therapy as well as in clinical stroke trials.
BACKGROUND AND PURPOSE: Perfusion-weighted imaging maps are used to identify hypoperfusion in acute ischemic stroke. We evaluated maps of cerebral blood flow (CBF), cerebral blood volume, mean transit time, and time to peak (TTP) in acute stroke by comparison with positron emission tomography. METHODS: Perfusion-weighted imaging and positron emission tomography were performed in 26 patients with acute ischemic stroke (median 18.5 hours after stroke onset, 65 minutes between MRI and positron emission tomography). The perfusion-weighted imaging-derived maps of CBF, cerebral blood volume, mean transit time, and TTP delay were compared with quantitative positron emission tomography CBF. A receiver-operating characteristic curve analysis identified the best perfusion-weighted imaging map and threshold to identify hypoperfusion <20 mL/100 g/min, a widely used measure of penumbral flow. RESULTS: Individual regression analysis of positron emission tomography CBF and perfusion-weighted imaging values were strong for CBF and TTP delay and weaker for mean transit time and cerebral blood volume, but the pooled analysis showed a large variance. Receiver-operating characteristic curve analysis identified TTP and CBF maps as most predictive (median area under the curve=0.94 and 0.93). Penumbral flow thresholds were <21.7 mL/100 g/min (CBF), <1.5 mL/100 g (cerebral blood volume), >5.3 seconds (mean transit time), and >4.2 seconds (TTP). TTP and CBF maps reached sensitivity/specificity values of 91%/82% and 89%/87%. CONCLUSIONS: In our sample, maps of CBF, TTP, and mean transit time yielded a good estimate of penumbral flow. The performance of TTP maps was equivalent to deconvolution techniques using an arterial input function. For all maps, the application of a predefined threshold is mandatory and calibration studies will enhance their use in acute stroke therapy as well as in clinical stroke trials.
Authors: Hongyu An; Andria L Ford; Yasheng Chen; Hongtu Zhu; Rosana Ponisio; Gyanendra Kumar; Amirali Modir Shanechi; Naim Khoury; Katie D Vo; Jennifer Williams; Colin P Derdeyn; Michael N Diringer; Peter Panagos; William J Powers; Jin-Moo Lee; Weili Lin Journal: Stroke Date: 2015-02-26 Impact factor: 7.914
Authors: Peter Werner; Dorothee Saur; Vilia Zeisig; Barbara Ettrich; Marianne Patt; Bernhard Sattler; Thies Jochimsen; Donald Lobsien; Philipp M Meyer; Florian Then Bergh; Antje Dreyer; Johannes Boltze; Joseph Classen; Dominik Fritzsch; Karl-Titus Hoffmann; Osama Sabri; Henryk Barthel Journal: J Cereb Blood Flow Metab Date: 2015-07-15 Impact factor: 6.200
Authors: Vince I Madai; Andreas Altaner; Katharina L Stengl; Olivier Zaro-Weber; Wolf Dieter Heiss; Federico C von Samson-Himmelstjerna; Jan Sobesky Journal: J Cereb Blood Flow Metab Date: 2011-03-09 Impact factor: 6.200
Authors: Mohammed Salman Shazeeb; Robert M King; Olivia W Brooks; Ajit S Puri; Nils Henninger; Johannes Boltze; Matthew J Gounis Journal: Transl Stroke Res Date: 2019-09-03 Impact factor: 6.829
Authors: Alexander Seiler; Nicholas P Blockley; Ralf Deichmann; Ulrike Nöth; Oliver C Singer; Michael A Chappell; Johannes C Klein; Marlies Wagner Journal: J Cereb Blood Flow Metab Date: 2017-09-20 Impact factor: 6.200
Authors: Chao Xu; Wolf U H Schmidt; Kersten Villringer; Peter Brunecker; Valerij Kiselev; Peter Gall; Jochen B Fiebach Journal: J Cereb Blood Flow Metab Date: 2011-04-06 Impact factor: 6.200