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(Stroke. 2005;36:44.)
© 2005 American Heart Association, Inc.

Original Contributions

Abnormal Intravoxel Cerebral Blood Flow Heterogeneity in Human Ischemic Stroke Determined by Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Jussi Perkiö, MSc; Lauri Soinne, MD; Leif Østergaard, MD, PhD; Johanna Helenius, MD, PhD; Aki Kangasmäki, PhD; Sami Martinkauppi, MD; Oili Salonen, MD, PhD; Sauli Savolainen, PhD; Markku Kaste, MD, PhD; Turgut Tatlisumak, MD Hannu J. Aronen, MD, PhD

From the HUS Helsinki Medical Imaging Center (J.P., S.M., O.S., S.S., H.J.A.), University of Helsinki, Helsinki, Finland; the Department of Child Neurology (J.P.), Helsinki University Central Hospital, Helsinki, Finland; the Department of Physical Sciences (J.P., S.S.), University of Helsinki, Helsinki, Finland; the Department of Neurology (L.S., J.H., M.K., T.T.), Helsinki University Central Hospital, Helsinki, Finland; the Department of Neuroradiology (L.Ø.), Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark; HUSLAB (A.K., S.S.), Department of Clinical Physiology & Nuclear Medicine, University of Helsinki, Helsinki, Finland; and the Functional Brain Imaging Unit (J.B., S.M., O.S., H.J.A.), Helsinki Brain Research Center, Helsinki, Finland.

Correspondence to Jussi Perkiö, MSc, Department of Child Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Lastenlinnantie 2, FIN-00290 Helsinki, Finland. E-mail jussi.perkio{at}hus.fi

Background and Purpose— The determination of cerebral blood flow heterogeneity (FH) by dynamic susceptibility contrast (DSC) magnetic resonance imaging has recently been proposed as a tool to predict final infarct size in acute stroke. In this study, we describe the evolution of FH during the first week as well as its correlation to the patients’ clinical status.

Methods— Ten patients with ischemic stroke were studied with DSC MRI and diffusion-weighted imaging in hyperacute (<6 hours) phase, at 24 hours, and 1 week after symptom onset. In addition to intravoxel FH, cerebral blood volume (CBV), cerebral blood flow (CBF), and contrast agent mean transit time (MTT) were determined from DSC MRI. All patients were evaluated neurologically with National Institute of Health Stroke Scale concurrently with the imaging sessions.

Results— All patients showed infarct growth, judged by diffusion-weighted imaging, during the week with simultaneous decrease in the sizes of FH, CBV, CBF, and MTT abnormalities. The FH abnormality was shown to be larger than CBV and CBF abnormalities at the hyperacute phase and 24 hours, but smaller than MTT abnormality in all 3 imaging sessions. The sizes of hyperacute FH, CBV, CBF, and MTT abnormalities correlated well with infarct size at 24 hours and at 1 week. Additionally, FH was the only perfusion parameter that correlated with the clinical score.

Conclusions— FH predicts infarct size equally well with the other perfusion parameters but is superior in correlation with the clinical score. FH can easily be incorporated to hyperacute stroke imaging without additional efforts.

Key Words: magnetic resonance imaging • perfusion • stroke

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