Mahmoud, M., Kadhim, M. (2023). The Value of MR Perfusion in Acute Ischemic Stroke. , 22(4), 440-447. doi: 10.52573/ipmj.2023.182289
Maha Mohammed Mahmoud; Mohammed Abd Kadhim. "The Value of MR Perfusion in Acute Ischemic Stroke". , 22, 4, 2023, 440-447. doi: 10.52573/ipmj.2023.182289
Mahmoud, M., Kadhim, M. (2023). 'The Value of MR Perfusion in Acute Ischemic Stroke', , 22(4), pp. 440-447. doi: 10.52573/ipmj.2023.182289
Mahmoud, M., Kadhim, M. The Value of MR Perfusion in Acute Ischemic Stroke. , 2023; 22(4): 440-447. doi: 10.52573/ipmj.2023.182289

The Value of MR Perfusion in Acute Ischemic Stroke

Iraqi Postgraduate Medical Journal
Volume 22, Issue 4, October 2023, Pages 440-447    PDF (321.06 K)
Document Type: Review Article
DOI: 10.52573/ipmj.2023.182289
Authors
Maha Mohammed Mahmoud* 1; Mohammed Abd Kadhim2
1Al-Imamian Al-Kadhimyian Medical city/ Baghdad Iraq.
2The Iraqi Board of Medical Specializations, Baghdad Iraq.‎
Abstract
BACKGROUND:
Stroke is a clinical diagnosis that refers to sudden onset focal neurological deficit of presumed vascular origin. MR perfusion (MRP) provide a rapid, quantitative, and easily interpretable visual assessment                   of the penumbra.
OBJECTIVE:
To study the value of MR perfusion in acute ischemic stroke within 1st 24hr.
PATIENTS AND METHODS:
Diffusion weighted images (DWI) and perfusion weighted images(PWI) were obtained in 30 ischemic stroke patients within 24 hours after symptoms onset. Perfusion diffusion mismatch (PDM) was analyzed by automated software that aligned apparent diffusion coefficient (ADC) defect with mean transient time (MTT) or time to maximum (Tmax) map.
RESULTS:
Type I (PWI>DWI) in (7) patients (23%), type II (PWI=DWI) is the main pattern described in (20) patients (67%). Average rCBF ratio was significantly reduced in the ischemic core (0.28±0.14)                      as compared to the normal brain tissue (0.51±0.14). Average rCBV ratio was significantly decreased in the ischemic core (0.35±0.15) as compared with the normal brain (0.90±0.88). MTT value was significantly higher in the infarct core (7.6 sec±0.92) than in the normal brain tissue (4.3sec±0.32).
There was significant reduction in average rCBF ratio in the penumbra (0.54±0.14) in comparison with normal brain tissue (0.66±0.14). A non-significant reduction in average rCBV ratio within penumbra (0.84± 0.29) in relation to normal brain tissue (0.98±0.25).  MTT value in the penumbra was significantly higher (4.6sec±0.45) than in the normal brain tissue (4.07sec±0.18).
CONCLUSION:
Type II PDM pattern was the dominant pattern in patient with acute ischemic stroke in the 1st 24 hours. Salvageable penumbra in type I PDM described in (78%) of patients. rCBF in penumbra was higher than ischemic core and lower than normal brain and was the most useful parameter in defining ischemic penumbra and for follow up of patients with acute ischemic stroke.
 
Keywords
Perfusion MRI; acute ischemic stroke
References
  1. Lloyd-Jones D, Adams RJ, Brown TM et al . Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121: e46-e215.
  2. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–54.
  3. Heit JJ, Wintermark M. Imaging selection for reperfusion therapy in acute ischemic stroke. Curr Treat Options Neurol 2015;17:332.
  4. Akbik F, Hirsch JA, Cougo-Pinto PT, et al.The evolution of mechanical thrombectomy for acute stroke.Curr Treat Options Cardiovasc Med. 2016;18:32.
  5. Heit JJ, Zaharchuk G, Wintermark M. Advanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment. Neuroimaging Clin N Am. 2018 ;28:585-97. 
  6. Bateman M, Slater LA, Leslie-Mazwi T, Simonsen CZ, Stuckey S, Chandra RV. Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection. Top MagnReson Imaging. 2017;26:77-82.
  7. Schaefer PW, Hunter GJ, He J, et al. Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol. 2002;23:1785–94.
  8. Campbell BC, Macrae IM. Translational perspectives on perfusion-diffusion mismatch in ischemic stroke. Int J Stroke. 2015;10:153–62.
  9. Butcher KS, Parsons M, MacGregor L, et al. Refining the perfusion-diffusion mismatch hypothesis. Stroke. 2005;36:1153–59.
  10. Ma H, Wright P, Allport L, et al. Salvage of the PWI/DWI mismatch up to 48 h from stroke onset leads to favorable clinical outcome. Int J Stroke. 2015;10:565–70.
  11. Demeestere Jelle, Wouters Anke, Christensen Soren . Review of Perfusion Imaging in Acute et al. Ischemic Stroke. Stroke. 2020;51:1017–24.
  12. Gür-Özmen S, Güngör-Tunçer Ö, Krespi Y. The effects of diffusion and perfusion MRI mismatch on the admission blood glucose and blood pressure values measured in the first 12 hours of acute stroke. Medicine (Baltimore). 2019;98:e16212.
  13. Hong C-T, Sun Y, Lu C-J et al . Prediction of infarct growth and neurologic deterioration in patients with positive perfusion-diffusion mismatch. Clin Neurol Neurosurg. 2012;114:376–80.
  14. Zhu G, Federau C, Wintermark M et al. Comparison of MRI IVIM and MR perfusion imaging in acute ischemic stroke due to large vessel occlusion. Int J Stroke Off J Int Stroke Soc. 2020;15:332–42.
  15. Bang OY, Saver JL, Lee KH et al. Characteristics of patients with target magnetic resonance mismatch profile: data from two geographically and racially distinct populations. Cerebrovasc Dis Basel Switz. 2010;29:87–94.
  16. Chen F, Ni Y-C. Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: An update. World J Radiol. 2012;4:63–74.
  17. Copen WA, Rezai Gharai L, Barak ER et al. Existence of the diffusion-perfusion mismatch within 24 hours after onset of acute stroke: dependence on proximal arterial occlusion. Radiology. 2009 ;250:878–86.
  18. H M, Ja Z, H T, L C, M G, J L, et al. Fragmentation of the classical magnetic resonance mismatch “penumbral” pattern with time. Stroke. 2009;40:3752–57.
  19. Liu Y, Karonen JO, Vanninen RL, Østergaard L et al. Cerebral Hemodynamics in Human Acute Ischemic Stroke: A Study with Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging and SPECT. J Cereb Blood Flow Metab. 2000;20:910–20.
  20. Grandin Cécile B., Duprez Thierry P., Smith Anne M. et al. Usefulness of Magnetic Resonance–Derived Quantitative Measurements of Cerebral Blood Flow and Volume in Prediction of Infarct Growth in Hyperacute Stroke. Stroke. 2001;32:1147–53.
  21. Zaharchuk G. Theoretical Basis of Hemodynamic MR Imaging Techniques to Measure Cerebral Blood Volume, Cerebral Blood Flow, and Permeability. Am J Neuroradiol. 2007;28:1850–58.
  22. Deutschmann H, Hinteregger N, Wießpeiner U. Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when using different software packages. Eur Radiol. 2021;31:658–65.
  23. Tong E, Hou Q, Fiebach JB, Wintermark M. The role of imaging in acute ischemic stroke. Neurosurg Focus. 2014;36:E3.
  24. Singer OC, de Rochemont R du M, Foerch C, et al. Relation between Relative Cerebral Blood Flow, Relative Cerebral Blood Volume, and Mean Transit Time in Patients with Acute Ischemic Stroke Determined by Perfusion-Weighted MRI. J Cereb Blood Flow Metab. 2003;23:605–11.
  25. Røhl L., Østergaard L., Simonsen C. Z., et al. Viability Thresholds of Ischemic Penumbra of Hyperacute Stroke Defined by Perfusion-Weighted MRI and Apparent Diffusion Coefficient. Stroke. 2001;32:1140–46.
 

Statistics
Article View: 314
PDF Download: 179


Journal Management System. Powered by iJournalPro.com