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Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative
Cécile B Grandin1, Thierry P Duprez, Anne M Smith
1Department of Medical Imaging, MRI Section, Cliniques Universitaires St Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium. grandin@rdgn.ucl.ac.be
Purpose:
To compare predictors of infarct growth in hyperacute stroke from a retrospective review of various relative and quantitative parameters calculated at perfusion-weighted magnetic resonance (MR) imaging performed within 6 hours after ictus.
Materials And Methods:
Fluid-attenuated inversion recovery and diffusion- and perfusion-weighted images were obtained in 66 patients. The initial infarct was delineated on diffusion-weighted images; the hemodynamic disturbance, on apparent mean transit time (MTT) maps; and the final infarct, on follow-up fluid-attenuated inversion recovery images. Relative (without and with deconvolution) and quantitative values of the bolus arrival time, time to peak (TTP), apparent MTT or MTT, cerebral blood volume (CBV), peak height, and cerebral blood flow (CBF) index or CBF were calculated for initial infarct, infarct growth (final minus initial infarct contour), viable hemodynamic disturbance (apparent MTT minus final infarct contour), and contralateral mirror regions. Univariate and multivariate analyses (receiver operating characteristic curves and discriminant analysis) were performed to compare the diagnostic performance of these parameters for predicting infarct growth.
Results:
At univariate analysis, relative peak height and quantitative CBF were the best predictors of infarct growth; at multivariate analysis, a function of peak height and TTP for relative measurements and CBF alone for quantitative measurements. Quantitative and relative measurements (without or with deconvolution) worked equally well. A combined relative peak height or TTP threshold (<54% or >5.2 seconds, respectively) had a sensitivity of 71% and a specificity of 98%. A quantitative CBF threshold (<35 mL/min/100 g) had a sensitivity of 69% and a specificity of 85%.
Conclusion:
A combination of relative peak height and TTP measurements allowed the best prediction of infarct growth, which obviates more complex quantitative calculation.
Insights
Predicting stroke infarct growth is possible using relative peak height and time to peak (TTP) measurements from perfusion imaging. These simpler relative metrics effectively predict infarct expansion, avoiding complex quantitative calculations.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hyperacute stroke management requires accurate prediction of infarct growth.
- Perfusion-weighted magnetic resonance (MR) imaging offers insights into hemodynamic disturbances.
- Identifying reliable predictors of infarct expansion is crucial for timely intervention.
Purpose of the Study:
- To compare various relative and quantitative parameters from perfusion-weighted MR imaging.
- To identify the best predictors of infarct growth within 6 hours after stroke onset.
- To evaluate the diagnostic performance of these parameters in predicting infarct expansion.
Main Methods:
- Retrospective review of 66 patients with hyperacute stroke.
- Acquisition of fluid-attenuated inversion recovery, diffusion, and perfusion-weighted MR images.
- Calculation of relative and quantitative hemodynamic parameters including time to peak (TTP) and cerebral blood flow (CBF).
- Analysis using univariate and multivariate methods (ROC curves, discriminant analysis).
Main Results:
- Relative peak height and quantitative CBF were significant univariate predictors of infarct growth.
- Multivariate analysis identified a function of peak height and TTP for relative measures, and CBF alone for quantitative measures.
- A combined threshold for relative peak height or TTP achieved 71% sensitivity and 98% specificity.
- A quantitative CBF threshold showed 69% sensitivity and 85% specificity.
Conclusions:
- A combination of relative peak height and TTP measurements provides the most accurate prediction of infarct growth.
- These relative measurements obviate the need for more complex quantitative calculations.
- Relative perfusion parameters offer a practical approach for predicting stroke infarct expansion.