Ahmed A Khalil1, Ann-Christin Ostwaldt2, Till Nierhaus2, Ramanan Ganeshan2, Heinrich J Audebert2, Kersten Villringer2, Arno Villringer2, Jochen B Fiebach2. 1. From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.). ahmed-abdelrahim.khalil@charite.de. 2. From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
Abstract
BACKGROUND AND PURPOSE: Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in stroke patients. METHODS: In 30 patients with acute (<24 hours) ischemic stroke, we performed Pearson correlation and multiple linear regression between DSC-MRI parameters (time to maximum [Tmax], mean transit time, cerebral blood flow, and cerebral blood volume) and BOLD-based parameters (BOLD delay and coefficient of BOLD variation). Prediction of severe hypoperfusion (Tmax >6 seconds) was assessed using receiver-operator characteristic (ROC) analysis. RESULTS: Correlation was highest between Tmax and BOLD delay (venous sinus reference; time shift range 7; median r=0.60; interquartile range=0.49-0.71). Coefficient of BOLD variation correlated with cerebral blood volume (median r= 0.37; interquartile range=0.24-0.51). Mean R2 for predicting BOLD delay by DSC-MRI was 0.54 (SD=0.2) and for predicting coefficient of BOLD variation was 0.37 (SD=0.17). BOLD delay (whole-brain reference, time shift range 3) had an area under the curve of 0.76 for predicting severe hypoperfusion (sensitivity=69.2%; specificity=80%), whereas BOLD delay (venous sinus reference, time shift range 3) had an area under the curve of 0.76 (sensitivity=67.3%; specificity=83.5%). CONCLUSIONS: BOLD delay is related to macrovascular delay and microvascular hypoperfusion, can identify severely hypoperfused tissue in acute stroke, and is a promising alternative to gadolinium contrast agent-based perfusion assessment in acute stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00715533 and NCT02077582.
BACKGROUND AND PURPOSE: Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in strokepatients. METHODS: In 30 patients with acute (<24 hours) ischemic stroke, we performed Pearson correlation and multiple linear regression between DSC-MRI parameters (time to maximum [Tmax], mean transit time, cerebral blood flow, and cerebral blood volume) and BOLD-based parameters (BOLD delay and coefficient of BOLD variation). Prediction of severe hypoperfusion (Tmax >6 seconds) was assessed using receiver-operator characteristic (ROC) analysis. RESULTS: Correlation was highest between Tmax and BOLD delay (venous sinus reference; time shift range 7; median r=0.60; interquartile range=0.49-0.71). Coefficient of BOLD variation correlated with cerebral blood volume (median r= 0.37; interquartile range=0.24-0.51). Mean R2 for predicting BOLD delay by DSC-MRI was 0.54 (SD=0.2) and for predicting coefficient of BOLD variation was 0.37 (SD=0.17). BOLD delay (whole-brain reference, time shift range 3) had an area under the curve of 0.76 for predicting severe hypoperfusion (sensitivity=69.2%; specificity=80%), whereas BOLD delay (venous sinus reference, time shift range 3) had an area under the curve of 0.76 (sensitivity=67.3%; specificity=83.5%). CONCLUSIONS: BOLD delay is related to macrovascular delay and microvascular hypoperfusion, can identify severely hypoperfused tissue in acute stroke, and is a promising alternative to gadolinium contrast agent-based perfusion assessment in acute stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00715533 and NCT02077582.
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