The potential of microvessel density in prediction of infarct growth: a two-month experimental study in vessel size imaging
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Published on: March 12, 2022
Chao Xu1, Wolf U H Schmidt, Ivana Galinovic
1Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. chao.xu@charite.de
Objectives:
Vessel size imaging is a novel technique to evaluate pathological changes of the microvessel density quantity Q and the mean vessel size index (VSI). As a follow-up study, we assessed these parameters for microscopic description of ischemic penumbra and their potentials in predicting lesion growth.
Methods:
Seventy-five patients with a perfusion-diffusion mismatch were examined within 24 h from symptom onset. We defined three regions of interest: the initial infarct (INF), the ischemic penumbra (IPE), and the healthy region (HEA) symmetric to the IPE. For 23 patients with a 6th-day follow-up, IPE regions were divided into areas of infarct growth and areas of oligemia.
Result:
The median values of Q and VSI were: for INF 0.29 s(-1/3) and 15.8 μm, for IPE 0.33 s(-1/3) and 20.6 μm and for HEA 0.36 s(-1/3) and 17.4 μm. The Q in the IPE was significantly smaller than in HEA, and VSI was significantly larger. The Q with a threshold of 0.32 s(-1/3) predicted the final infarction with a sensitivity of 69% and a specificity of 64%.
Conclusions:
The reduced Q and increased VSI in the IPE confirmed our previous pilot results. Although Q showed a trend to identify the severity of ischemia in an overall voxel population, its potential in predicting infarct growth needs to be further tested in a larger cohort including a clear status of reperfusion and recanalization.
Insights
Vessel size imaging parameters, microvessel density quantity (Q), and mean vessel size index (VSI), show potential in describing ischemic penumbra. Reduced Q and increased VSI in the penumbra may indicate severity, but predicting infarct growth requires further study.
Area of Science:
- Neurology
- Medical Imaging
- Microcirculation Research
Background:
- Vessel size imaging offers novel insights into microvascular changes.
- Microvessel density quantity (Q) and mean vessel size index (VSI) assess pathological changes.
- Understanding the ischemic penumbra is crucial for stroke management.
Purpose of the Study:
- To evaluate microvessel density quantity (Q) and mean vessel size index (VSI) in the ischemic penumbra.
- To assess the potential of these parameters in predicting lesion growth in stroke patients.
- To microscopically describe the ischemic penumbra using vessel size imaging.
Main Methods:
- Seventy-five patients with perfusion-diffusion mismatch underwent vessel size imaging within 24 hours of symptom onset.
- Regions of interest included initial infarct (INF), ischemic penumbra (IPE), and healthy contralateral region (HEA).
- For 23 patients, IPE regions were analyzed for infarct growth and oligemia on day 6.
Main Results:
- Median Q values were 0.29 s(-1/3) for INF, 0.33 s(-1/3) for IPE, and 0.36 s(-1/3) for HEA.
- Median VSI values were 15.8 μm for INF, 20.6 μm for IPE, and 17.4 μm for HEA.
- Reduced Q and increased VSI were observed in the IPE compared to HEA. Q predicted final infarction with 69% sensitivity and 64% specificity at a 0.32 s(-1/3) threshold.
Conclusions:
- Reduced Q and increased VSI in the ischemic penumbra align with previous findings.
- While Q shows a trend for indicating ischemia severity, its predictive power for infarct growth needs further investigation.
- Larger cohorts with detailed reperfusion data are necessary to validate Q's predictive potential for infarct growth.
