A Novel Method to Derive Separate Gray and White Matter Cerebral Blood Flow Measures from MR Imaging of Acute Ischemic Stroke Patients

Simon, Jessica; Bristow, Mike; Lu, Hong; Lauzon, M. Louis; Brown, Robert A.; Manjón, José V.; Eliasziw, Michael; Frayne, Richard; Buchan, Alastair M.; Demchuk, Andrew M.; Mitchell, J. Ross

doi:10.1038/sj.jcbfm.9600130

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…We analyzed the time course of CBF and ADC in 5 tissue compartments of the brain that are typically involved with focal cerebral ischemia. 15,16 All 5 predefined tissue compartments were present in the eMCAO model and only 3 in the sMCAO model, demonstrating a more heterogeneous perfusion pattern in eMCAO rats compared with sMCAO rats, potentially because of the same variables responsible for the intermodel differences in the extent of CBF lesion volume. Tissue compartments with sustained and transient reversal of the diffusion/perfusion mismatch were typically located in the periphery of the critically hypoperfused tissue in eMCAO animals, and the ADC decrease in the ischemic core was more pronounced in sMCAO group compared with eMCAO group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Ischemic Lesion Evolution in Embolic Versus Mechanical Middle Cerebral Artery Occlusion in Sprague Dawley Rats Using Diffusion and Perfusion Imaging

Henninger

Sicard

Schmidt

et al. 2006

Stroke

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Background and Purpose-Differences among models in the temporal evolution of ischemia after middle cerebral artery occlusion (MCAO) in rats may considerably influence the results of experimental stroke research. Using diffusion and perfusion imaging, we compared the spatiotemporal evolution of ischemia in Sprague Dawley rats after permanent suture MCAO (sMCAO; nϭ8) and embolic MCAO (eMCAO; nϭ8). Methods-Serial measurements of quantitative cerebral blood flow (CBF) and the apparent diffusion coefficient (ADC)were performed up to 180 minutes after MCAO. ADC and CBF values within 5 different brain regions were analyzed. ADC and CBF lesion volumes were calculated by using previously established viability thresholds and correlated with infarct volume defined by 2,3,5-triphenyltetrazolium chloride staining 24 hours after MCAO. Results-Compared with sMCAO animals, the threshold-derived CBF lesion volume was significantly larger in eMCAO at all time points (PϽ0.01), remained relatively constant over time, and was highly correlated with the 2,3,5-triphenyltetrazolium chloride-defined infarct size. The ADC lesion volume did not differ between models at any time point. A diffusion/perfusion mismatch was present significantly longer in eMCAO animals (PϽ0.05), and these rats demonstrated larger absolute mismatch volumes that were statistically significant at 30, 60, and 90 minutes (PϽ0.05).In both models, CBF and ADC declines were highly correlated. Conclusion-This study demonstrated substantial differences in acute ischemic lesion evolution between the eMCAO and sMCAO models.

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Section: Discussionmentioning

confidence: 99%

“…11,14 In addition, ROIs 2 and 3 were selected because recent studies show their presence in human embolic stroke and suggest they may help define potential tissue fates within the diffusion/perfusion mismatch. 15,16 …”

Section: Region Of Interest Analysismentioning

confidence: 99%

Comparison of Ischemic Lesion Evolution in Embolic Versus Mechanical Middle Cerebral Artery Occlusion in Sprague Dawley Rats Using Diffusion and Perfusion Imaging

Henninger

Sicard

Schmidt

et al. 2006

Stroke

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“…4 In humans, although the fate of WM versus GM has rarely been studied, our results are consistent with the available data, irrespective of the imaging approach. [1][2][3]9,10 For instance, a positron emission tomography study using the hypoxia tracer 18 F-misonidazole found salvageable tissue in WM at later time points than in GM, suggesting that the former has a slower evolution toward infarction. 2 At earlier time points and using perfusion DWI, the same investigators again emphasized the greater resistance of WM to ischemia.…”

Section: Discussionmentioning

confidence: 99%

Is White Matter More Prone to Diffusion Lesion Reversal After Thrombolysis?

Tisserand

Malherbe

Turc

et al. 2014

Stroke

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Background and Purpose— In acute ischemic stroke, white matter (WM) is considered more resistant to infarction than gray matter (GM). To test this hypothesis, we compared the fate of WM and GM voxels belonging to the acute diffusion-weighted imaging (DWI) lesion, expecting WM voxels to be more prone to reversal after thrombolysis. Methods— Reversible acute DWI (RAD) lesion was defined voxel-wise as an acute lesion on initial DWI (DWI 1 ) with no visible lesion on 24-hour DWI (DWI 2 ). Only patients with RAD lesions >10 mL and >10% of DWI 1 from our previously reported cohort were eligible. The core was defined as voxels hyperintense on DWI 1 and DWI 2 . Semiautomated segmentation of DWI 1 , core, and RAD lesions, normalization into standard space, and WM/GM segmentation allowed calculations of WM/GM proportions in each region of interest using a voxel-counting algorithm. Results— Thirty patients were eligible (RAD lesion median volume [interquartile range], 23.3 mL [19.1–35.0 mL]; onset-to-treatment time, 134 minutes [105–185 minutes]). WM voxels fraction was greater in RAD lesions than in the core (59.4% [52.8%–68.9%] versus 49.6% [43.0%–57.5%]; P =0.011). The proportion of reversibility was greater for WM than for GM voxels (60.8% [25.5%–88.7%] versus 53.5% [21.1%–77.3%]; P =0.02). The percentage of RAD lesions increased with the proportion of WM present in the acute DWI lesion ( P <0.0001; R =0.67). Conclusions— Acute DWI lesions predominantly involving WM may be more prone to reversal and, hence, to respond to therapy than their GM counterparts.

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“…Several previously published reports are based on this cohort [7][8][9][10] . The inclusion criteria were National Institutes of Health Stroke Scale (NIHSS) score ≥ 4, diffusion-weighted images (DWI; b = 1,000 s/mm 2 ) and perfusion-weighted images (PWI) consistent with an acute anterior circulation ischemic stroke and admission MRI completed within 6 h for patients treated with intravenous tPA or within 12 h if conservative treatment was proposed. No patient received intra-arterial therapy.…”

Section: Patients and Clinical Datamentioning

confidence: 99%

“…The different vulnerability of the white matter (WM) and gray matter (GM) compartments to ischemia reflects their distinct thresholds of cerebral blood flow (CBF) and metabolism [1][2][3] . Neuroprotective and reperfusion ther-apies aim to salvage the ischemic penumbra.…”

Section: Introductionmentioning

confidence: 99%

MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter

Berner¹,

Cho²,

Haesebaert

et al. 2016

Cerebrovasc Dis

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Background: In acute ischemic stroke (AIS), gray matter (GM) and white matter (WM) have different vulnerabilities to ischemia. Thus, we compared the evolution of ischemic lesions within WM and GM using MRI. Methods: From a European multicenter prospective database (I-KNOW), available T1-weighted images were identified for 50 patients presenting with an anterior AIS and a perfusion weighted imaging (PWI)/diffusion weighted imaging (DWI) mismatch ratio of 1.2 or more. Six lesion compartments were outlined: initial DWI (b = 1,000 s/mm²) lesion, initial PWI-DWI mismatch (T_max >4 s and DWI-negative), final infarct mapped on 1-month fluid-attenuated inversion recovery (FLAIR) imaging, lesion growth between acute DWI and 1-month FLAIR, DWI lesion reversal at 1 month and salvaged mismatch. The WM and GM were segmented on T1-weighted images, and all images were co-registered within subjects to the baseline MRI. WM and GM proportions were calculated for each compartment. Results: Fifty patients were eligible for the study. Median delay between symptom onset and baseline MRI was 140 min. The percentage of WM was significantly greater in the following compartments: initial mismatch (52.5 vs. 47.5%, p = 0.003), final infarct (56.7 vs. 43.3%, p < 0.001) and lesion growth (58.9 vs. 41.2%, p < 0.001). No significant difference was found between GM and WM percentages within the initial DWI lesion, DWI reversal and salvaged mismatch compartments. Conclusions: Ischemic lesions may extend preferentially within the WM. Specific therapeutic strategies targeting WM ischemic processes may deserve further investigation.

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A Novel Method to Derive Separate Gray and White Matter Cerebral Blood Flow Measures from MR Imaging of Acute Ischemic Stroke Patients

Cited by 22 publications

References 21 publications

Comparison of Ischemic Lesion Evolution in Embolic Versus Mechanical Middle Cerebral Artery Occlusion in Sprague Dawley Rats Using Diffusion and Perfusion Imaging

Comparison of Ischemic Lesion Evolution in Embolic Versus Mechanical Middle Cerebral Artery Occlusion in Sprague Dawley Rats Using Diffusion and Perfusion Imaging

Is White Matter More Prone to Diffusion Lesion Reversal After Thrombolysis?

MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter

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