Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging

Craig A. Robertson, Christopher McCabe, M. Rosario Lopez-Gonzalez, Graeme A. Deuchar, Krishna Dani, William M. Holmes, Keith W. Muir, Celestine Santosh, I. Mhairi Macrae

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Acute ischemic stroke is common and disabling, but there remains a paucity of acute treatment options and available treatment (thrombolysis) is underutilized. Advanced brain imaging, designed to identify viable hypoperfused tissue (penumbra), could target treatment to a wider population. Existing magnetic resonance imaging and computed tomography-based technologies are not widely used pending validation in ongoing clinical trials. T2* oxygen challenge magnetic resonance imaging, by providing a more direct readout of tissue viability, has the potential to identify more patients likely to benefit from thrombolysis - irrespective of time from stroke onset - and patients within and beyond the 4·5 h thrombolysis treatment window who are unlikely to benefit and are at an increased risk of hemorrhage. This study employs serial multimodal imaging and voxel-based analysis to develop optimal data processing for T2* oxygen challenge penumbra assessment. Tissue in the ischemic hemisphere is compartmentalized into penumbra, ischemic core, or normal using T2* oxygen challenge (single threshold) or T2* oxygen challenge plus cerebral blood flow (dual threshold) data. Penumbra defined by perfusion imaging/apparent diffusion coefficient mismatch (dual threshold) is included for comparison.  Permanent middle cerebral artery occlusion was induced in male Sprague-Dawley rats (n = 6) prior to serial multimodal imaging: T2* oxygen challenge, diffusion-weighted and perfusion imaging (cerebral blood flow using arterial spin labeling).  Across the different methods evaluated, T2* oxygen challenge combined with perfusion imaging most closely predicted 24 h infarct volume. Penumbra volume declined from one to four-hours post-stroke: mean ± SD, 77 ± 44 to 49 ± 37 mm(3) (single T2* oxygen challenge-based threshold); 55 ± 41 to 37 ± 12 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 84 ± 64 to 42 ± 18 mm(3) (dual cerebral blood flow/apparent diffusion coefficient), as ischemic core grew: 155 ± 37 to 211 ± 36 mm(3) (single apparent diffusion coefficient threshold); 178 ± 56 to 205 ± 33 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 139 ± 30 to 168 ± 38 mm(3) (dual cerebral blood flow/apparent diffusion coefficient). There was evidence of further lesion growth beyond four-hours (T2-defined edema-corrected infarct, 231 ± 19 mm(3) ).  In conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.

LanguageEnglish
Pages42-50
Number of pages9
JournalInternational Journal of Stroke
Volume10
Issue number1
Early online date15 Jul 2014
DOIs
Publication statusPublished - Jan 2015

Fingerprint

Cerebrovascular Circulation
Perfusion
Oxygen
Perfusion Imaging
Multimodal Imaging
Tissue Survival
Stroke
Magnetic Resonance Imaging
Middle Cerebral Artery Infarction
Therapeutics
Neuroimaging
Sprague Dawley Rats
Edema
Tomography
Clinical Trials
Hemorrhage
Technology
Growth

Keywords

  • ischemic penumbra
  • neuroimaging
  • oxygen challenge
  • T2* MRI

Cite this

Robertson, C. A., McCabe, C., Lopez-Gonzalez, M. R., Deuchar, G. A., Dani, K., Holmes, W. M., ... Macrae, I. M. (2015). Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging. International Journal of Stroke , 10(1), 42-50. https://doi.org/10.1111/ijs.12327
Robertson, Craig A. ; McCabe, Christopher ; Lopez-Gonzalez, M. Rosario ; Deuchar, Graeme A. ; Dani, Krishna ; Holmes, William M. ; Muir, Keith W. ; Santosh, Celestine ; Macrae, I. Mhairi. / Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging. In: International Journal of Stroke . 2015 ; Vol. 10, No. 1. pp. 42-50.
@article{d0792c56e6164426a37c631617a44ef6,
title = "Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging",
abstract = "Acute ischemic stroke is common and disabling, but there remains a paucity of acute treatment options and available treatment (thrombolysis) is underutilized. Advanced brain imaging, designed to identify viable hypoperfused tissue (penumbra), could target treatment to a wider population. Existing magnetic resonance imaging and computed tomography-based technologies are not widely used pending validation in ongoing clinical trials. T2* oxygen challenge magnetic resonance imaging, by providing a more direct readout of tissue viability, has the potential to identify more patients likely to benefit from thrombolysis - irrespective of time from stroke onset - and patients within and beyond the 4·5 h thrombolysis treatment window who are unlikely to benefit and are at an increased risk of hemorrhage. This study employs serial multimodal imaging and voxel-based analysis to develop optimal data processing for T2* oxygen challenge penumbra assessment. Tissue in the ischemic hemisphere is compartmentalized into penumbra, ischemic core, or normal using T2* oxygen challenge (single threshold) or T2* oxygen challenge plus cerebral blood flow (dual threshold) data. Penumbra defined by perfusion imaging/apparent diffusion coefficient mismatch (dual threshold) is included for comparison.  Permanent middle cerebral artery occlusion was induced in male Sprague-Dawley rats (n = 6) prior to serial multimodal imaging: T2* oxygen challenge, diffusion-weighted and perfusion imaging (cerebral blood flow using arterial spin labeling).  Across the different methods evaluated, T2* oxygen challenge combined with perfusion imaging most closely predicted 24 h infarct volume. Penumbra volume declined from one to four-hours post-stroke: mean ± SD, 77 ± 44 to 49 ± 37 mm(3) (single T2* oxygen challenge-based threshold); 55 ± 41 to 37 ± 12 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 84 ± 64 to 42 ± 18 mm(3) (dual cerebral blood flow/apparent diffusion coefficient), as ischemic core grew: 155 ± 37 to 211 ± 36 mm(3) (single apparent diffusion coefficient threshold); 178 ± 56 to 205 ± 33 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 139 ± 30 to 168 ± 38 mm(3) (dual cerebral blood flow/apparent diffusion coefficient). There was evidence of further lesion growth beyond four-hours (T2-defined edema-corrected infarct, 231 ± 19 mm(3) ).  In conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.",
keywords = "ischemic penumbra, neuroimaging, oxygen challenge, T2* MRI",
author = "Robertson, {Craig A.} and Christopher McCabe and Lopez-Gonzalez, {M. Rosario} and Deuchar, {Graeme A.} and Krishna Dani and Holmes, {William M.} and Muir, {Keith W.} and Celestine Santosh and Macrae, {I. Mhairi}",
year = "2015",
month = "1",
doi = "10.1111/ijs.12327",
language = "English",
volume = "10",
pages = "42--50",
journal = "International Journal of Stroke",
issn = "1747-4930",
number = "1",

}

Robertson, CA, McCabe, C, Lopez-Gonzalez, MR, Deuchar, GA, Dani, K, Holmes, WM, Muir, KW, Santosh, C & Macrae, IM 2015, 'Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging' International Journal of Stroke , vol. 10, no. 1, pp. 42-50. https://doi.org/10.1111/ijs.12327

Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging. / Robertson, Craig A.; McCabe, Christopher; Lopez-Gonzalez, M. Rosario; Deuchar, Graeme A.; Dani, Krishna; Holmes, William M.; Muir, Keith W.; Santosh, Celestine; Macrae, I. Mhairi.

In: International Journal of Stroke , Vol. 10, No. 1, 01.2015, p. 42-50.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging

AU - Robertson, Craig A.

AU - McCabe, Christopher

AU - Lopez-Gonzalez, M. Rosario

AU - Deuchar, Graeme A.

AU - Dani, Krishna

AU - Holmes, William M.

AU - Muir, Keith W.

AU - Santosh, Celestine

AU - Macrae, I. Mhairi

PY - 2015/1

Y1 - 2015/1

N2 - Acute ischemic stroke is common and disabling, but there remains a paucity of acute treatment options and available treatment (thrombolysis) is underutilized. Advanced brain imaging, designed to identify viable hypoperfused tissue (penumbra), could target treatment to a wider population. Existing magnetic resonance imaging and computed tomography-based technologies are not widely used pending validation in ongoing clinical trials. T2* oxygen challenge magnetic resonance imaging, by providing a more direct readout of tissue viability, has the potential to identify more patients likely to benefit from thrombolysis - irrespective of time from stroke onset - and patients within and beyond the 4·5 h thrombolysis treatment window who are unlikely to benefit and are at an increased risk of hemorrhage. This study employs serial multimodal imaging and voxel-based analysis to develop optimal data processing for T2* oxygen challenge penumbra assessment. Tissue in the ischemic hemisphere is compartmentalized into penumbra, ischemic core, or normal using T2* oxygen challenge (single threshold) or T2* oxygen challenge plus cerebral blood flow (dual threshold) data. Penumbra defined by perfusion imaging/apparent diffusion coefficient mismatch (dual threshold) is included for comparison.  Permanent middle cerebral artery occlusion was induced in male Sprague-Dawley rats (n = 6) prior to serial multimodal imaging: T2* oxygen challenge, diffusion-weighted and perfusion imaging (cerebral blood flow using arterial spin labeling).  Across the different methods evaluated, T2* oxygen challenge combined with perfusion imaging most closely predicted 24 h infarct volume. Penumbra volume declined from one to four-hours post-stroke: mean ± SD, 77 ± 44 to 49 ± 37 mm(3) (single T2* oxygen challenge-based threshold); 55 ± 41 to 37 ± 12 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 84 ± 64 to 42 ± 18 mm(3) (dual cerebral blood flow/apparent diffusion coefficient), as ischemic core grew: 155 ± 37 to 211 ± 36 mm(3) (single apparent diffusion coefficient threshold); 178 ± 56 to 205 ± 33 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 139 ± 30 to 168 ± 38 mm(3) (dual cerebral blood flow/apparent diffusion coefficient). There was evidence of further lesion growth beyond four-hours (T2-defined edema-corrected infarct, 231 ± 19 mm(3) ).  In conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.

AB - Acute ischemic stroke is common and disabling, but there remains a paucity of acute treatment options and available treatment (thrombolysis) is underutilized. Advanced brain imaging, designed to identify viable hypoperfused tissue (penumbra), could target treatment to a wider population. Existing magnetic resonance imaging and computed tomography-based technologies are not widely used pending validation in ongoing clinical trials. T2* oxygen challenge magnetic resonance imaging, by providing a more direct readout of tissue viability, has the potential to identify more patients likely to benefit from thrombolysis - irrespective of time from stroke onset - and patients within and beyond the 4·5 h thrombolysis treatment window who are unlikely to benefit and are at an increased risk of hemorrhage. This study employs serial multimodal imaging and voxel-based analysis to develop optimal data processing for T2* oxygen challenge penumbra assessment. Tissue in the ischemic hemisphere is compartmentalized into penumbra, ischemic core, or normal using T2* oxygen challenge (single threshold) or T2* oxygen challenge plus cerebral blood flow (dual threshold) data. Penumbra defined by perfusion imaging/apparent diffusion coefficient mismatch (dual threshold) is included for comparison.  Permanent middle cerebral artery occlusion was induced in male Sprague-Dawley rats (n = 6) prior to serial multimodal imaging: T2* oxygen challenge, diffusion-weighted and perfusion imaging (cerebral blood flow using arterial spin labeling).  Across the different methods evaluated, T2* oxygen challenge combined with perfusion imaging most closely predicted 24 h infarct volume. Penumbra volume declined from one to four-hours post-stroke: mean ± SD, 77 ± 44 to 49 ± 37 mm(3) (single T2* oxygen challenge-based threshold); 55 ± 41 to 37 ± 12 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 84 ± 64 to 42 ± 18 mm(3) (dual cerebral blood flow/apparent diffusion coefficient), as ischemic core grew: 155 ± 37 to 211 ± 36 mm(3) (single apparent diffusion coefficient threshold); 178 ± 56 to 205 ± 33 mm(3) (dual T2* oxygen challenge/cerebral blood flow); 139 ± 30 to 168 ± 38 mm(3) (dual cerebral blood flow/apparent diffusion coefficient). There was evidence of further lesion growth beyond four-hours (T2-defined edema-corrected infarct, 231 ± 19 mm(3) ).  In conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.

KW - ischemic penumbra

KW - neuroimaging

KW - oxygen challenge

KW - T2 MRI

UR - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1747-4949

U2 - 10.1111/ijs.12327

DO - 10.1111/ijs.12327

M3 - Article

VL - 10

SP - 42

EP - 50

JO - International Journal of Stroke

T2 - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 1

ER -