This Article Full Text Full Text (PDF) All Versions of this Article: 34/10/2534    most recent 01.STR.0000092396.70827.28v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heiss, W.-D. Search for Related Content PubMed PubMed Citation Articles by Heiss, W.-D.

(Stroke. 2003;34:2534.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Best Measure of Ischemic Penumbra: Positron Emission Tomography

From the Max Planck Institute for Neurological Research, Köln, Germany.

Correspondence to Prof Dr W.-D. Heiss, Max-Planck-Institut für neurologische Forschung, Gleueler Str. 50, 50931 Köln, Germany. E-mail wdh@pet.mpin-koeln.mpg.de

Key Words: cerebral blood flow • tomography, emission computed • penumbra • stroke, ischemic

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The ischemic penumbra was defined by Astrup et al¹ as brain tissue perfused at a level within the thresholds of functional impairment and morphological integrity, which has the capacity to recover if perfusion is improved. Because tolerance of tissue to ischemic damage is dependent on residual flow and duration of flow disturbance,² the ischemic penumbra characterizes a transient condition: it exists for a short period even in the center of ischemia, and may extend to increasing time periods in the more or less hypoperfused surrounding tissue. The concept of the ischemic penumbra has been developed from animal experiments in which regional flow measurements could be clearly related to the functional/morphological state of the tissue. Its transfer to the clinical situation requires the definition of 3 critical values that usually cannot be assessed in the acute stage of ischemic stroke: (1) quantitation of flow in the core and the periphery of the territory with impaired blood supply; (2) state of the various tissue compartments within the affected area with respect to irreversibly damaged or preserved morphology; and (3) the time period the respective tissue compartments have been exposed to more or less severe hypoperfusion. As all clinically available methods at best yield only momentary assessments of brain perfusion and tissue condition at several hours after the vascular attack, the development of these changes over time remains obscure, and predictions on the fate of the tissue from the measurable variables must be vague. Therefore, the definition of penumbra tissue in the clinical . . . [Full Text of this Article]

This article has been cited by other articles:

				P.W. Schaefer, L. Roccatagliata, C. Ledezma, B. Hoh, L.H. Schwamm, W. Koroshetz, R.G. Gonzalez, and M.H. Lev First-Pass Quantitative CT Perfusion Identifies Thresholds for Salvageable Penumbra in Acute Stroke Patients Treated with Intra-arterial Therapy AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 20 - 25. [Abstract] [Full Text] [PDF]