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From the Departments of Neurology (Dr. Schlaug, A. Benfield, and Drs. Baird and Warach) and Radiology (Drs. Siewert, Lövblad, Edelman, and Warach) and Biometrics Center (R.A. Parker), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Address correspondence and reprint requests to Dr. Gottfried Schlaug, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; or Dr. Steven Warach, National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, 10 Center Drive, Room 3B10A, MSC 1250, Bethesda, MD 20892.
BACKGROUND: Identifying tissue at risk for infarction is important in deciding which patients would benefit most from potentially harmful therapies and provides a way to evaluate newer therapies with regard to the amount of ischemic tissue salvaged.
OBJECTIVE: To operationally define and characterize cerebral tissue at risk for stroke progression.
METHODS: We retrospectively selected 25 patients with an acute onset of a hemispheric stroke from our database who had undergone a combination of two diffusion-weighted MRI studies and a perfusion-weighted MRI study. We applied a logistic regression model using maps of the relative mean transit time and relative cerebral blood flow (rCBF) as well as three different maps of the relative cerebral blood volume (rCBV) to predict an operationally defined penumbra (region of mismatch between the diffusion lesion on day 1 and its extension 24 to 72 hours later).
RESULTS: Maps of the rCBF and initial rCBV were significant predictors for identifying penumbral tissue. Our operationally defined penumbral region was characterized by a reduction in the initial rCBV (47% of contralateral control region [CCR]), an increase (163% of CCR) in the total rCBV, and a reduction (37% of CCR) in the rCBF, whereas the operationally defined ischemic core showed a more severe reduction in the rCBF (12% of CCR) and in the initial rCBV (19% of CCR).
CONCLUSION: These MR indexes may allow the identification and quantification of viable but ischemically threatened cerebral tissue amenable to therapeutic interventions in the hyperacute care of stroke patients.
Key words: Ischemic penumbra—Diffusion-weighted imaging—Cerebrovascular disease—MRI—Ischemic stroke.
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