Trevor K Carpenter | PubMed Health

PubMed2006

Persistent infarct hyperintensity on diffusion-weighted imaging late after stroke indicates heterogeneous, delayed, infarct evolution.

BACKGROUND AND PURPOSE: Some infarcts have persistently hyperintense areas on diffusion-weighted MRI (DWI) even at 1 month after stroke, whereas others have become isointense to normal brain. We hypothesized that late DWI hyperintensity reflected different infarct evolution compared with areas that were isointense by 1 month. METHODS: We recruited patients prospectively with ischemic stroke, performed DWI and perfusion-weighted MRI (PWI) on admission, at 5 days, 14 days, and 1 month after stroke, and assessed functional outcome at 3 months (Rankin Scale). Patient characteristics and DWI/PWI values were compared for patients with or without "still hyperintense" infarct areas on 1-month DWI. RESULTS: Among 42 patients, 27 (64%) had "still hyperintense" infarct regions at 1 month, mostly in white matter. Patients with "still hyperintense" regions at 1 month had lower baseline apparent diffusion coefficient ratio (ADCr; mean+/-SD 0.76+/-0.12 versus 0.85+/-0.12; hyperintense versus isointense; P<0.05), prolonged reduction of ADCr (repeated-measures ANOVA; P<0.01), no difference in baseline perfusion but delayed normalization of mean transit time (P<0.05) and cerebral blood flow ratios (repeated measures ANOVA; P<0.05), initially more severe stroke, and worse 3-month outcome than patients whose lesions were isointense by 1 month. CONCLUSIONS: The late DWI lesion hyperintensity emphasizes the heterogeneity in temporal evolution of stroke injury and suggests ongoing "ischemia." Lower baseline ADCr precedes delayed perfusion normalization, suggesting that worse cell swelling impedes reperfusion. Further study is required to determine underlying mechanisms and any potential for subacute intervention to improve recovery.

Adult↗

PubMed2006

DSC perfusion MRI-Quantification and reduction of systematic errors arising in areas of reduced cerebral blood flow.

Dynamic susceptibility contrast (DSC)-MRI is commonly used to measure cerebral perfusion in acute ischemic stroke. Quantification of perfusion parameters involves deconvolution of the tissue concentration-time curves with an arterial input function (AIF), typically with the use of singular value decomposition (SVD). To mitigate the effects of noise on the estimated cerebral blood flow (CBF), a regularization parameter or threshold is used. Often a single global threshold is applied to every voxel, and its value has a dramatic effect on the CBF values obtained. When a single global threshold was applied to simulated concentration-time curves produced using exponential, triangular, and boxcar residue functions, significant systematic errors were found in the measured perfusion parameters. We estimate the errors obtained for different sampling intervals and signal-to-noise ratios (SNRs), and discuss the source of the systematic error. We present a method that partially corrects for the systematic error in the presence of an exponential residue function by applying a linear fit, which removes underestimates of long mean transit time (MTT) and overestimates of short MTT. For example, the correction reduced the error at a temporal resolution of 2.5 s and an SNR of 30 from 29.1% to 11.7%. However, the error is largest in the presence of noise and at MTTs that are likely to be encountered in areas of hypoperfusion; furthermore, even though it is reduced, it cannot be corrected for exactly.

Algorithms↗