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Updated: Jan 25, 2026
Human Fetal Blood Flow Quantification with Magnetic Resonance Imaging and Motion Compensation
Published on: January 7, 2021
Collateral blood flow measurement with intravoxel incoherent motion perfusion imaging in hyperacute brain stroke
Christian Federau1, Max Wintermark2, Soren Christensen2
1From the Department of Neuroradiology (C.F., M.W., D.G.M., G.Z., B.W.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, Stanford University, CA; Institute for Biomedical Engineering (C.F.), ETH Zürich and University of Zürich; and Department of Radiology, University Hospital Basel and University of Basel (C.F.), Switzerland. federau@biomed.ee.ethz.ch.
Objective:
To determine if intravoxel incoherent motion (IVIM) magnetic resonance perfusion can measure the quality of the collateral blood flow in the penumbra in hyperacute stroke.
Methods:
A 6 b values IVIM MRI sequence was acquired in stroke patients with large vessel occlusion imaged <16 hours of last seen well. IVIM perfusion measures were evaluated in regions of interest drawn in the infarct core (D < 600 mm2/s), in the corresponding region in the contralateral hemisphere, and in the dynamic susceptibility contrast penumbra. In patients with a penumbra >15 mL, images were reviewed for the presence of a penumbra perfusion lesion on the IVIM f map, which was correlated with infarct size metrics. Statistical significance was tested using Student t test, Mann-Whitney U test, and Fisher exact test.
Results:
A total of 34 patients were included. In the stroke core, IVIM f was significantly lower (4.6 ± 3.3%) compared to the healthy contralateral region (6.3 ± 2.2%, p < 0.001). In the 25 patients with a penumbra >15 mL, 9 patients had an IVIM penumbra perfusion lesion (56 ± 76 mL), and 16 did not. Patients with an IVIM penumbra perfusion lesion had a larger infarct core (82 ± 84 mL) at baseline, a larger infarct growth (68 ± 40 mL), and a larger final infarct size (126 ± 81 mL) on follow-up images compared to the patients without (resp. 20 ± 17 mL, p < 0.05; 13 ± 19 mL, p < 0.01; 29 ± 24 mL, p < 0.05). All IVIM penumbra perfusion lesions progressed to infarction despite thrombectomy treatment.
Conclusions:
IVIM is a promising tool to assess the quality of the collateral blood flow in hyperacute stroke. IVIM penumbra perfusion lesion may be a marker of nonsalvageable tissue despite treatment with thrombectomy, suggesting that the IVIM penumbra perfusion lesion might be counted to the stroke core, together with the DWI lesion.
Insights
Intravoxel incoherent motion (IVIM) MRI can assess collateral blood flow in hyperacute stroke patients. An IVIM penumbra perfusion lesion indicates non-salvageable tissue, suggesting it should be included with DWI lesions in the stroke core definition.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hyperacute stroke management requires accurate assessment of collateral blood flow.
- Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) offers potential for evaluating tissue perfusion.
- Understanding penumbra quality is critical for treatment decisions in large vessel occlusion stroke.
Purpose of the Study:
- To evaluate the utility of IVIM perfusion MRI in measuring collateral blood flow in the penumbra of hyperacute stroke patients.
- To determine if IVIM can identify non-salvageable tissue within the penumbra.
Main Methods:
- Acquired 6 b-value IVIM MRI sequences in stroke patients with large vessel occlusion (<16 hours).
- Assessed IVIM perfusion measures in infarct core, contralateral hemisphere, and penumbra regions.
- Correlated IVIM penumbra perfusion lesions with infarct size metrics and treatment outcomes.
Main Results:
- IVIM fractional flow (f) was significantly lower in the stroke core compared to the contralateral hemisphere (p < 0.001).
- In patients with a significant penumbra, an IVIM penumbra perfusion lesion was associated with larger baseline infarct core, greater infarct growth, and larger final infarct size.
- All identified IVIM penumbra perfusion lesions progressed to infarction despite thrombectomy.
Conclusions:
- IVIM MRI is a promising tool for assessing collateral blood flow quality in hyperacute stroke.
- An IVIM penumbra perfusion lesion may signify non-salvageable brain tissue, even after thrombectomy.
- Consider including IVIM penumbra perfusion lesions in the definition of the stroke core alongside DWI lesions.
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