Related Experiment Video
Updated: Jun 6, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using
Thomas Ritzenthaler1, Tae-Hee Cho, Marlène Wiart
1Cerebrovascular Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Bron, France.
Introduction:
The value of perfusion MRI for identifying the tissue at risk has been questioned. Our objective was to assess baseline perfusion-weighted imaging parameters within infarct progression areas.
Methods:
Patients with anterior circulation stroke without early reperfusion were included from a prospective MRI database. Sequential MRI examinations were performed on admission, 2-3 h (H2), 2-3 days (D2), and between 15 and 30 days after the initial MRI. Maps of baseline time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were calculated. Lesion extension areas were defined as pixels showing de novo lesions between each MRI and were generated by subtracting successive lesion masks: V(0), baseline diffusion-weighted imaging (DWI) lesion; V(1), lesion extension between baseline and H2 DWI; V(2), lesion extension from H2 to D2 DWI; and V(3), lesion extension from D2 DWI to final FLAIR. Repeated measures analysis was used to compare hemodynamic parameters within the baseline diffusion lesion and subsequent lesion extension areas.
Results:
Thirty-two patients were included. Baseline perfusion parameters were significantly more impaired within the acute DWI lesion compared to lesion extension areas (TTP, p < 0.0001; MTT, p < 0.0001; CBF p < 0.0001; CBV, p < 0.0001). A significant decrease in MTT (p = 0.01) and TTP (p = 0.01) was found within successive lesion growth areas.
Conclusion:
A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas.
Insights
Perfusion MRI reveals more severe impairments in acute stroke lesions compared to expanding areas. Time-to-peak and mean transit time show a decreasing severity gradient in successive infarct growth zones.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- The diagnostic value of perfusion MRI in identifying tissue at risk during stroke is debated.
- Assessing baseline perfusion-weighted imaging parameters in areas of infarct progression is crucial.
Purpose of the Study:
- To evaluate baseline perfusion-weighted imaging parameters within areas of infarct progression in anterior circulation stroke patients.
- To determine if perfusion MRI can accurately characterize tissue at risk.
Main Methods:
- Prospective study of anterior circulation stroke patients without early reperfusion.
- Sequential MRI scans (baseline, 2-3h, 2-3 days, 15-30 days) to assess lesion evolution.
- Calculation of time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) maps.
Main Results:
- Baseline perfusion parameters (TTP, MTT, CBF, CBV) were significantly more impaired in acute diffusion-weighted imaging (DWI) lesions compared to subsequent lesion extension areas.
- A significant decrease in MTT and TTP was observed in successive infarct growth areas.
Conclusions:
- A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas.
- Perfusion MRI parameters demonstrate distinct patterns in acute lesions versus areas of progression.
