Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory: Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging

Liu, Yi Jui; Chen, Cheng-Yu; Chung, Hsiao Wen; Huang, Ing Jye; Lee, Chang Shin; Chin, Shy-Chyi; Liou, Michelle

doi:10.1148/radiol.2292020639

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…6 Furthermore, the observed abnormalities in lactate and NAA in mismatch regions are consistent with published data showing increased lactate and reduced NAA outside ADC or DWI lesion boundaries, 3,7 including in the early stages after stroke. 8 The small number of patients is a limitation of our study. A major strength, however, is that each patient was carefully studied with 3 parameters of stroke-related injury (MRSI markers, DWI abnormalities, National Institutes of Health Stroke Scale scores), each measured before, during, and after therapy.…”

Section: Discussionmentioning

confidence: 94%

Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke

Singhal

Ratai

Benner

et al. 2007

Stroke

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Background and Purpose-Recent studies suggest that normobaric oxygen therapy (NBO) is neuroprotective in acute ischemic stroke. Methods-We performed multivoxel magnetic resonance spectroscopic imaging and diffusion/perfusion MRI in patients with stroke treated with NBO or room air. Imaging was performed before, during, and after therapy. Results-Voxel-based analysis showed excellent correlation between apparent diffusion coefficient values, lactate, and N-acetyl-aspartate levels at all time points. Lactate decreased during NBO and increased post-NBO. N-acetyl-aspartate decreased in patients receiving room air but not in NBO-treated patients. Conclusion-These data suggest that NBO improves aerobic metabolism and preserves neuronal integrity in the ischemic brain. (Stroke. 2007;38:2851-2854.)Key Words: diffusion-weighted magnetic resonance imaging Ⅲ neuroprotection Ⅲ oxygen therapy Ⅲ proton magnetic resonance spectroscopic imaging Ⅲ stroke T he results of recent studies suggest that normobaric oxygen therapy (NBO) is neuroprotective in acute ischemic stroke. 1 In contrast to hyperbaric oxygenation, which has multiple molecular/biochemical effects, NBO's mechanisms are relatively unknown. We investigated NBO's metabolic effects on acutely ischemic brain tissues using multivoxel magnetic resonance spectroscopic imaging (MRSI) and diffusion-perfusion MRI (DWI and PWI). MethodsMRSI was performed in seven patients; one data set was discarded due to poor coregistration and motion artifact. Analyzable data were obtained in 6 patients, including 5 consecutively enrolled in a pilot study of NBO in stroke. 1 Detailed patient selection criteria are published 1 ; eligible patients were Ͻ12 hours postsymptom onset with perfusion-diffusion "mismatch" on baseline MRI. After informed consent, patients were randomized to room air or NBO (45 L/min oxygen through a face mask for 8 hours). MRSI and DWI/PWI were performed at baseline, 4 hours (during therapy), and 24 hours. National Institutes of Health Stroke Scale scores were recorded before each scan. The local human research committee approved the study.Details of the DWI/PWI technique are published. 1 MRSI was obtained at the end of each serial imaging session, on an axial image coregistered to the DWI image showing the largest hyperintense lesion, using the PROBE-P sequence. MRSI grids were carefully placed to encompass DWI-bright, mismatch, and normal brain regions, avoiding cerebrospinal fluid spaces (Figure 1). Multivoxel spectra were acquired over 6.5 minutes with symmetric 220-mm field of view; 16ϫ16 phase-encoding steps; 10-mm slice thickness; TR/TEϭ1500/135. DICOM and GE raw data were processed on a SUN-Blade-100 workstation (Sun Microsystems) using the SAGE spectral analysis program (General Electric) for preprocessing, which includes 1.25-Hz spectral apodization, internal waterreferencing, and spatial-zerofilling before Fourier transformation. Spatial-zerofilling resulted in 32ϫ32 spectra yielding individual voxel sizes of 7ϫ7ϫ10 mm 3 (0.5 mL). Quantities of lactate (La...

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Section: Discussionmentioning

confidence: 94%

Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke

Singhal

Ratai

Benner

et al. 2007

Stroke

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“…We confirmed the results of one previous study which showed a correlation between ADC and the ratio of [lesion NAA]:[NAAϩcholineϩcreatine] found in 6 patients, 11 but metabolite ratios should be used with caution because lesion choline is not normal, 26 and methods for quantifying metabolites are now well established. Others found reduced NAA in areas of cerebral blood flow reduction using single photon computed tomography, 27,28 MR PWI, 10 or transcranial Doppler ultrasound, 29,30 but did not correlate metabolite and blood flow levels. The observation that larger diffusion lesions were associated with lower NAA and higher lactate values is consistent with previous studies showing that large lesions on T2 weighted imaging had lower NAA and higher lactate than small lesions.…”

Section: Discussionmentioning

confidence: 97%

Associations Between Diffusion and Perfusion Parameters, N -Acetyl Aspartate, and Lactate in Acute Ischemic Stroke

Cvoro

Wardlaw

Marshall

et al. 2009

Stroke

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Background and Purpose-In acute ischemic stroke, the amount of neuronal damage in hyperintense areas on MR diffusion imaging (DWI) is unclear. We used spectroscopic imaging to measure N-acetyl aspartate (NAA, a marker of normal neurons) and lactate (a marker of ischemia) to compare with diffusion and perfusion values in the diffusion lesion in acute ischemic stroke. Methods-We recruited patients with acute ischemic stroke prospectively and performed MR diffusion weighted (DWI), perfusion, and spectroscopic imaging. We coregistered the images, outlined the visible diffusion lesion, and extracted metabolite, perfusion, and apparent diffusion coefficient (ADC) values from the diffusion lesion. Results-42 patients were imaged, from 1.5 to 24 hours after stroke. In the DWI lesion, although NAA was reduced, there was no correlation between NAA and ADC or perfusion values.

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“…Articles in category 5 primarily described perfusion imaging to characterize infarct types or to better understand infarcts. [47][48][49][50][51][52] Those in category 6 compared the size of perfusion imaging deficits with the size of simultaneous abnormalities on DWI. 53,54 Articles in category 7 compared CT and MR perfusion imaging results with perfusion imaging results obtained by use of other techniques.…”

Section: Explanation Of Categories Of Articles With Use Of Perfusion mentioning

confidence: 99%

Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease

Provenzale¹,

Shah²,

Patel³

et al. 2008

AJNR Am J Neuroradiol

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Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory: Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging

Abstract: The different temporal patterns for stroke progression in TI and WI are associated with different evolutions of hemodynamics and neuronal injury.

Cited by 16 publications

References 26 publications

Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke

Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke

Associations Between Diffusion and Perfusion Parameters, N -Acetyl Aspartate, and Lactate in Acute Ischemic Stroke

Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease

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