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Related Concept Videos

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Oxygen Extraction Fraction on Baseline MRI Predicts Infarction Growth in Successfully Reperfused Patients.

Mona Asghariahmadabad1, Ameera Ismail2, Pouya Metanat1

  • 1Department of Radiology and Biomedical Imaging (M.A., P.M., D.S., D.L.C., S.W.H., M.R.A., K.H.N., C.P.H., K.N.), University of California, San Francisco.

Stroke
|August 4, 2025
PubMed
Summary

Lower oxygen extraction fraction (OEF) in the penumbra predicts significant infarct growth in acute ischemic stroke patients after reperfusion. This imaging biomarker, relative OEF (OEFr), can identify those at risk for further ischemic injury.

Keywords:
infarctionischemiamagnetic resonance imagingoxygenreperfusion

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Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Sciences

Background:

  • Infarct growth complicates acute ischemic stroke recovery even after successful reperfusion.
  • Oxygen extraction fraction (OEF) quantifies ischemic tissue viability.
  • Dynamic susceptibility contrast perfusion MRI enables OEF quantification.

Purpose of the Study:

  • To assess the association between pretreatment relative oxygen extraction fraction (OEFr) in ischemic tissue and infarct growth after successful reperfusion in acute ischemic stroke.
  • To determine if OEFr is a predictor of infarct expansion in stroke patients.

Main Methods:

  • Retrospective cohort study of 89 acute ischemic stroke patients with anterior circulation large vessel occlusion and successful reperfusion.
  • Pretreatment dynamic susceptibility contrast perfusion MRI was used to quantify OEFr within the ischemic core and penumbra.
  • Infarct growth (≥10 mL) was the primary outcome, assessed via posttreatment MRI within 48 hours of reperfusion.

Main Results:

  • 37% of patients experienced substantial infarct growth (≥10 mL).
  • Significantly lower penumbra OEFr values were observed in patients with infarct growth (P<0.0001).
  • Penumbra OEFr demonstrated a significant association with infarct growth (β=-2.9, P=0.007) and penumbra-to-infarct conversion ratio (β=-10.4, P=0.028).

Conclusions:

  • Pretreatment penumbra OEFr is a valuable imaging biomarker for predicting infarct growth in acute ischemic stroke patients post-reperfusion.
  • Elevated penumbra OEFr appears protective against further ischemic injury.
  • Lower penumbra OEFr values are linked to increased infarct expansion.