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Updated: Aug 21, 2026
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Improved prediction of final infarct volume using bolus delay-corrected perfusion-weighted MRI: implications for the
Stephen E Rose1, Andrew L Janke, Mark Griffin
1Centre for Magnetic Resonance, University of Queensland 4072, Brisbane, Australia. Stephen.Rose@cmr.uq.edu.au
Background And Purpose:
Magnetic resonance imaging (MRI)-based perfusion measures using dynamic susceptibility contrast are extremely useful for identification of ischemic penumbral tissue in acute stroke. However, errors in the measurement of cerebral blood flow (CBF) and mean transit time (MTT) can occur. The aim of this study was to investigate whether bolus delay-corrected (BDC) perfusion measures enable better delineation of the ischemic penumbra.
Methods:
Diffusion-weighted MRI (DWI) and perfusion-weighted MRI data were acquired from 19 acute stroke patients. Perfusion abnormalities were manually defined on BDC perfusion maps (corrected MTT [cMTT] and corrected CBF [cCBF]), and on maps derived from an arterial input function placed within the contralateral (CBF, MTT) and ipsilateral (ipsilateral CBF [iCBF] and ipsilateral MTT [iMTT]) middle cerebral artery. Perfusion lesion volumes were correlated with 30-day T2-weighted MRI lesion volumes and with clinical outcome using the National Institutes of Health Stroke Scale (NIHSS).
Results:
Spearman correlation coefficients for comparing lesion volumes delineated on DWI, CBF, iCBF, cCBF, MTT, iMTT, and cMTT maps with 30-day T2-weighted lesion volumes were 0.72, 0.87, 0.88, 0.90, 0.84, 0.92, and 0.96, respectively (all P<0.001). The analogous correlation coefficients for comparing 30-day National Institutes of Health Stroke Scale (NIHSS) scores were 0.39 (NS), 0.69 (NS), 0.75 (P<0.001), 0.62 (NS), 0.72 (P<0.001), 0.78 (P<0.001), and 0.83 (P<0.001), respectively.
Conclusions:
Uncorrected perfusion lesion volumes overestimated the extent of ischemic injury. BDC perfusion measures (cMTT) correlated more accurately with final lesion volume and clinical outcome. Such measures offer an improved estimation of the final infarct size in acute stroke.
Insights
Bolus delay-corrected (BDC) perfusion measures in acute stroke improve the accuracy of estimating final infarct size. These corrected measures, particularly corrected mean transit time (cMTT), better correlate with lesion volume and clinical outcomes.
Area of Science:
- Neuroimaging
- Stroke Imaging
- Perfusion MRI
Background:
- Dynamic susceptibility contrast MRI perfusion measures are vital for identifying ischemic penumbra in acute stroke.
- Inaccurate measurements of cerebral blood flow (CBF) and mean transit time (MTT) can occur.
- Bolus delay-corrected (BDC) methods aim to improve perfusion assessment accuracy.
Purpose of the Study:
- To investigate if BDC perfusion measures enhance the delineation of the ischemic penumbra.
- To assess the correlation of BDC perfusion measures with final lesion volume and clinical outcome.
Main Methods:
- Acquired diffusion-weighted MRI (DWI) and perfusion-weighted MRI data from 19 acute stroke patients.
- Defined perfusion abnormalities on BDC maps (cMTT, cCBF) and uncorrected maps (CBF, MTT, iCBF, iMTT).
- Correlated perfusion lesion volumes with 30-day T2-weighted MRI lesion volumes and NIHSS scores.
Main Results:
- BDC measures, especially cMTT, showed the highest correlation with 30-day T2 lesion volumes (r=0.96).
- cMTT also demonstrated the strongest correlation with 30-day NIHSS scores (r=0.83).
- Uncorrected perfusion lesion volumes tended to overestimate ischemic injury.
Conclusions:
- BDC perfusion measures, particularly cMTT, provide a more accurate estimation of final infarct size in acute stroke.
- These improved measures enhance the correlation with both final lesion volume and clinical outcomes.
- BDC perfusion mapping offers a valuable tool for acute stroke management.
