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(Stroke. 2000;31:1097.)
© 2000 American Heart Association, Inc.

Original Contributions

Combined Diffusion-Weighted and Perfusion-Weighted Flow Heterogeneity Magnetic Resonance Imaging in Acute Stroke

Leif Østergaard, MD, MSc; A. Gregory Sorensen, MD; David A. Chesler, PhD; Robert M. Weisskoff, PhD; Walter J. Koroshetz, MD, PhD; Ona Wu, BSc; Carsten Gyldensted, MD, PhD Bruce R. Rosen, MD, PhD

From the Department of Radiology, MGH NMR Center (A.G.S., D.A.C., R.M.W., O.W., B.R.R.), Massachusetts General Hospital, Charlestown, Mass; Harvard Medical School (A.G.S., R.M.W., B.R.R., W.J.K., D.A.C.), Boston, Mass; Harvard-MIT Division of Health Sciences (R.M.W., O.W., B.R.R.), Cambridge, Mass; Stroke Unit (W.J.K.), Department of Neurology, Massachusetts General Hospital, Boston, Mass; and Department of Neuroradiology (L.Ø., C.G.), Århus University Hospital, Århus, Denmark.

Correspondence to Leif Østergaard, MD, MSc, Department of Neuroradiology, Århus Kommunehospital, Nørrebrogade 44, DK-8000 Århus C, Denmark. E-mail leif{at}pet.auh.dk

Background and Purpose—The heterogeneity of microvascular flows is known to be an important determinant of the efficacy of oxygen delivery to tissue. Studies in animals have demonstrated decreased flow heterogeneity (FH) in states of decreased perfusion pressure. The purpose of the present study was to assess microvascular FH changes in acute stroke with use of a novel perfusion-weighted MRI technique and to evaluate the ability of combined diffusion-weighted MRI and FH measurements to predict final infarct size.

Methods—Cerebral blood flow, FH, and plasma mean transit time (MTT) were measured in 11 patients who presented with acute (<12 hours after symptom onset) stroke. Final infarct size was determined with follow-up MRI or CT scanning.

Results—In normal brain tissue, the distribution of relative flows was markedly skewed toward high capillary flow velocities. Within regions of decreased cerebral blood flow, plasma MTT was prolonged. Furthermore, subregions were identified with significant loss of the high-flow component of the flow distribution, thereby causing increased homogeneity of flow velocities. In parametric maps that quantify the acute deviation of FH from that of normal tissue, areas of extreme homogenization of capillary flows predicted final infarct size on follow-up scans of 10 of 11 patients.

Conclusions—Flow heterogeneity and MTT can be rapidly assessed as part of a routine clinical MR examination and may provide a tool for planning of individual stroke treatment, as well as in targeting and evaluation of emerging therapeutic strategies.

Key Words: cerebral blood flow • magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted • microcirculation

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