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Cerebral blood flow predicts lesion growth in acute stroke patients
Jens Fiehler1, Michael von Bezold, Thomas Kucinski
1Department of Neuroradiology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. fiehler@uke.uni-hamburg.de
Background And Purpose:
We sought to study the role of MRI-derived cerebral blood flow (CBF) measurements for the prediction of lesion development in acute stroke patients.
Methods:
Thirty-two patients were treated with tissue plasminogen activator. Diffusion-weighted (DWI) and perfusion-weighted MRI, T2-weighted imaging, and MR angiography were performed before treatment (2.8+/-0.9 hours after symptom onset) and on follow-up (days 1 and 7). CBF thresholds (12 and 22 mL/100 g per minute) were applied to bolus tracking MRI maps to determine predictive cutoff levels.
Results:
In 21 patients (group A), the terminal lesion volume (T2-weighted imaging) was larger than the initial DWI lesion volume (89+/-93 versus 21+/-38 mL). In 11 patients (group B), the terminal lesion volume was smaller than the initial DWI lesion volume (7+/-27 versus 15+/-29 mL). The initial DWI lesion volume did not differ between both groups. The presence of a tissue volume > or =50 mL with a CBF value < or =12 mL/100 g per minute was predictive for lesion enlargement to day 7 in T2-weighted imaging (positive predictive value, 0.80).
Conclusions:
The presence of a tissue volume > or =50 mL with a CBF value < or =12 mL/100 g per minute predicts further lesion growth in hyperacute stroke patients. MRI-derived CBF values, with all their present limitations, are valuable in early estimation of prognosis of stroke patients.
Insights
Cerebral blood flow (CBF) MRI measurements can predict stroke lesion growth. A tissue volume of at least 50 mL with CBF below 12 mL/100 g/min indicates future lesion enlargement in acute stroke patients.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute stroke management requires accurate prognostication.
- Early prediction of lesion development is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the predictive role of MRI-derived cerebral blood flow (CBF) for lesion development in acute stroke.
- To establish cutoff levels for CBF measurements to predict stroke progression.
Main Methods:
- 32 acute stroke patients treated with tissue plasminogen activator underwent diffusion-weighted (DWI), perfusion-weighted MRI, T2-weighted imaging, and MR angiography.
- CBF thresholds (12 and 22 mL/100 g/min) were applied to perfusion maps to identify predictive cutoff levels.
- Lesion volumes were assessed using DWI and T2-weighted imaging at baseline, day 1, and day 7.
Main Results:
- Patients were categorized into two groups based on lesion volume changes: those with lesion enlargement (Group A) and those with lesion reduction (Group B).
- The presence of a tissue volume >= 50 mL with a CBF value <= 12 mL/100 g/min was a significant predictor of lesion enlargement by day 7 (positive predictive value, 0.80).
- Initial DWI lesion volume did not significantly differ between groups, highlighting the importance of perfusion parameters.
Conclusions:
- MRI-derived CBF measurements, specifically a tissue volume >= 50 mL with CBF <= 12 mL/100 g/min, are valuable for predicting lesion growth in hyperacute stroke.
- These findings support the use of CBF in the early estimation of stroke patient prognosis, despite current limitations.