(Stroke. 2001;32:1140.)
© 2001 American Heart Association, Inc.
Original Contributions |
Viability Thresholds of Ischemic Penumbra of Hyperacute Stroke Defined by Perfusion-Weighted MRI and Apparent Diffusion Coefficient
From the Department of Neuroradiology (L.R., L.Ø., C.Z.S., P.V.-P., C.G.) and the Department of Neurology (G.A.), Aarhus University Hospital, Aarhus, Denmark; the Department of Neurosurgery (M.S.), University of Ehime, Ehime, Japan; and SHFJ (D.L.B.), CEA, Orsay, France.
Correspondence to Lisbeth Røhl, MD, Department of Neuroradiology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark. E-mail Lisbeth{at}pet.auh.dk
Background and Purpose—The penumbra of ischemic stroke consists of hypoperfused, but not irreversibly damaged, tissue surrounding the ischemic core. The purpose of this study was to determine viability thresholds in the ischemic penumbra, defined as the perfusion/diffusion mismatch in hyperacute stroke, by the use of diffusion- and perfusion-weighted MRI (DWI and PWI, respectively).
Methods—DWI and PWI
were performed in 11 patients 
6 hours after the onset of symptoms of
acute ischemic stroke. Regions of interest (ROIs) were placed
covering the ischemic core (ROI 1), the penumbra that
progressed to infarction on the basis of follow-up scans (ROI 2), and
the penumbra that recovered (ROI 3). The ratios of relative cerebral
blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit
time (MTT), and apparent diffusion coefficient were calculated as
lesion ROIs relative to the contralateral mirror
ROIs.
Results—The post hoc analysis showed that the penumbra progressed to infarction at the following cutoff values: rCBF <0.59 and MTT >1.63. Higher sensitivity and accuracy in predicting outcome of the penumbra were obtained from the rCBF maps compared with the rCBV and MTT maps. The initial rCBV and apparent diffusion coefficient ratios did not differentiate between the part of the penumbra that recovered and the part that progressed to infarction. The mean rCBF ratio was optimal in distinguishing the parts of the penumbra recovering or progressing to infarction.
Conclusions—The thresholds found in this study by combined DWI/PWI might aid in the selection of patients suitable for therapeutic intervention within 6 hours. However, these hypothesized thresholds need to be prospectively tested at the voxel level on a larger patient sample before they can be applied clinically.
Key Words: MRI, diffusion-weighted • MRI, perfusion-weighted • penumbra • stroke, acute
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