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Related Experiment Videos

Identifying thresholds for penumbra and irreversible tissue damage.

Wolf-Dieter Heiss1, Jan Sobesky, Volker Hesselmann

  • 1Max Planck Institute for Neurological Research, University of Cologne, Germany. wdh@pet.mpin-koeln.mpg.de

Stroke
|October 2, 2004
PubMed
Summary

Diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) show promise for acute stroke therapy selection. However, DWI correlates better with positron emission tomography (PET) for predicting infarct volume than PWI, which is less reliable for identifying penumbra.

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Area of Science:

  • Neuroimaging
  • Radiology
  • Stroke Medicine

Background:

  • Diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) are used to identify viable brain tissue in acute stroke patients.
  • Semiquantitative measures from DWI and PWI have limitations in defining irreversible damage and penumbra.
  • Positron emission tomography (PET) offers quantitative measures of blood flow and metabolism for comparison.

Purpose of the Study:

  • To compare DWI and PWI findings with PET measurements in acute stroke patients.
  • To evaluate the accuracy of MRI in predicting infarct volume and identifying penumbra.
  • To assess the reliability of PWI/DWI mismatch for penumbra detection.

Main Methods:

  • Comparative study involving three groups of acute stroke patients.

Related Experiment Videos

  • Group 1: DWI compared with 11C-flumazenil (FMZ) PET and subsequent infarct volume.
  • Group 2: PWI compared with [15O]H2O PET for cerebral blood flow.
  • Group 3: PWI/DWI mismatch compared with PET for cerebral blood flow and oxygen consumption.

    • Main Results:

    • DWI and apparent diffusion coefficient (ADC) predicted final infarct volume with reasonable accuracy, but with higher false-positive rates than FMZ PET.
    • A time-to-peak (TTP) delay of 4-6 seconds in PWI provided a fair estimate of hypoperfusion.
    • PWI/DWI mismatch did not reliably identify penumbra, often overestimating its volume.

    Conclusions:

    • DWI is a good predictor of acute tissue damage and final infarct volume, correlating well with FMZ PET.
    • PWI measures, particularly TTP, appear less reliable for assessing hypoperfusion.
    • The PWI/DWI mismatch is not a reliable correlate of penumbra and may overestimate its extent.