Andrew Bivard1, Nawaf Yassi2, Venkatesh Krishnamurthy3, Longting Lin3, Christopher Levi3, Neil J Spratt3, Ferdi Mittef3, Stephen Davis2, Mark Parsons3. 1. Department of Neurology, John Hunter Hospital, University of Newcastle, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. andrew.bivard@newcastle.edu.au. 2. Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. 3. Department of Neurology, John Hunter Hospital, University of Newcastle, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
Abstract
INTRODUCTION: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery. METHODS: One hundred ten anterior circulation ischemic stroke patients presenting to hospital within 4.5 h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24 h after stroke onset, including single-voxel, short-echo-time (30 ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area. RESULTS: The concentrations of total creatine (5.39 vs 5.85 mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13 mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24 h (r (2) = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24 h (r (2) = 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001). CONCLUSION: Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24 h and greater disability at 3 months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.
INTRODUCTION: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery. METHODS: One hundred ten anterior circulation ischemic strokepatients presenting to hospital within 4.5 h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24 h after stroke onset, including single-voxel, short-echo-time (30 ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area. RESULTS: The concentrations of total creatine (5.39 vs 5.85 mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13 mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24 h (r (2) = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24 h (r (2) = 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001). CONCLUSION: Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24 h and greater disability at 3 months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.
Authors: Yoshinari Nagakane; Soren Christensen; Caspar Brekenfeld; Henry Ma; Leonid Churilov; Mark W Parsons; Christopher R Levi; Kenneth S Butcher; Andre Peeters; P Alan Barber; Christopher F Bladin; Deidre A De Silva; John Fink; Thomas E Kimber; David W Schultz; Keith W Muir; Brian M Tress; Patricia M Desmond; Stephen M Davis; Geoffrey A Donnan Journal: Stroke Date: 2010-12-02 Impact factor: 7.914
Authors: M W Parsons; T Li; P A Barber; Q Yang; D G Darby; P M Desmond; R P Gerraty; B M Tress; S M Davis Journal: Neurology Date: 2000-08-22 Impact factor: 9.910
Authors: Victoria E O'Collins; Malcolm R Macleod; Geoffrey A Donnan; Laura L Horky; Bart H van der Worp; David W Howells Journal: Ann Neurol Date: 2006-03 Impact factor: 10.422
Authors: A M Hakim; R P Pokrupa; J Villanueva; M Diksic; A C Evans; C J Thompson; E Meyer; Y L Yamamoto; W H Feindel Journal: Ann Neurol Date: 1987-03 Impact factor: 10.422
Authors: Muhammad E Haque; Refaat E Gabr; Sarah D George; Seth B Boren; Farhaan S Vahidy; Xu Zhang; Octavio D Arevalo; Susan Alderman; Ponnada A Narayana; Khader M Hasan; Elliott R Friedman; Clark W Sitton; Sean I Savitz Journal: Front Neurol Date: 2019-02-25 Impact factor: 4.003