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Updated: Mar 27, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Acute Stroke Syndromes with Isolated Hypoperfusion on MRI - A Clinical and MRI Study
Angelika Alonso1, Kristina Szabo, Marc E Wolf
1Department of Neurology, Universitx00E4;tsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
Background:
Acute stroke syndromes with negative diffusion-weighted imaging (DWI) but extensive perfusion deficits are rare and constitute a diagnostic challenge due to different operational definitions of penumbral hypoperfusion in acute stroke patients based on MRI criteria.
Methods:
MR profiles of 19 patients presenting with acute stroke syndromes with negative DWI in the presence of an extensive area of hypoperfusion on time-to-peak (TTP) maps of dynamic susceptibility contrast perfusion-weighted imaging (PWI) were analysed. DWI and PWI lesions were quantified and interpreted with regard to the clinical course.
Results:
Despite the large area of abnormal perfusion on TTP maps, the clinical course was benign (median National Institute of Health Stroke Scale 2 at admission, 0 at discharge). The volume of hypoperfused tissue was significantly smaller on postprocessed TTP maps with a TTP delay of >4 s than on unprocessed TTP maps with manual contrast adjustment. Semiquantitatively assessed TTP lesion volume was associated with the presence of DWI lesions on follow-up.
Conclusion:
TTP maps are highly sensitive to demonstrate even small-scale perfusion abnormalities. The additional information from TTP delay thresholds indicates critically reduced perfusion and appears to be a good prognostic indicator in combination with MR angiography and symptomatology.
Insights
Acute stroke with negative diffusion-weighted imaging (DWI) but perfusion deficits can be diagnosed using time-to-peak (TTP) maps. These maps help identify critically reduced perfusion and predict outcomes in stroke patients.
Area of Science:
- Neuroimaging
- Stroke Medicine
- Radiology
Background:
- Acute stroke syndromes with negative diffusion-weighted imaging (DWI) and extensive perfusion deficits present diagnostic challenges.
- Varied operational definitions of penumbral hypoperfusion based on MRI criteria complicate diagnosis.
Purpose of the Study:
- To analyze MR profiles of acute stroke patients with negative DWI and extensive hypoperfusion on time-to-peak (TTP) maps.
- To evaluate the correlation between perfusion deficits and clinical outcomes.
Main Methods:
- Analysis of MR profiles (DWI and PWI) in 19 patients with acute stroke syndromes.
- Quantification of DWI and PWI lesions using dynamic susceptibility contrast perfusion-weighted imaging (PWI) and TTP maps.
- Interpretation of lesion volumes in relation to clinical course.
Main Results:
- Patients with extensive hypoperfusion on TTP maps but negative DWI showed a benign clinical course.
- Postprocessed TTP maps with a TTP delay >4 s revealed significantly smaller hypoperfused tissue volumes.
- Semiquantitatively assessed TTP lesion volume correlated with the presence of follow-up DWI lesions.
Conclusions:
- Time-to-peak (TTP) maps are sensitive in detecting even small perfusion abnormalities in acute stroke.
- TTP delay thresholds provide valuable information on critically reduced perfusion.
- TTP delay thresholds, combined with MR angiography and clinical symptoms, serve as a good prognostic indicator.
