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. 2021 Aug;31(8):6323-6333.
doi: 10.1007/s00330-020-07485-2. Epub 2021 Jan 29.

Quantitative susceptibility-weighted imaging may be an accurate method for determining stroke hypoperfusion and hypoxia of penumbra

Xiudi Lu  1 , Linglei Meng  2 , Yongmin Zhou  3 , Shaoshi Wang  2 , Miller Fawaz  4 , Meiyun Wang  5 , E Mark Haacke  4 , Chao Chai  6 , Meizhu Zheng  7 , Jinxia Zhu  8 , Yu Luo  9 , Shuang Xia  10
Affiliations

Quantitative susceptibility-weighted imaging may be an accurate method for determining stroke hypoperfusion and hypoxia of penumbra

Xiudi Lu et al. Eur Radiol. 2021 Aug.

Abstract

Objectives: To quantitatively evaluate the volume of the ischemic penumbra using susceptibility-weighted imaging and mapping (SWIM) of asymmetrical prominent cortical veins (APCVs) in patients with acute ischemic stroke.

Methods: Eighty-five eligible patients with acute ischemic stroke on admission within 12 h from symptom onset were studied. The APCVs on SWIM were quantitatively (SWI-volume) and semi-quantitatively (SWI-Alberta Stroke Program Early CT Score, SWI-ASPECTS) evaluated to calculate mismatch. To assess the diagnostic efficacy of APCVs on SWIM, comparative analyses were performed between SWIvolume-DWI mismatch and SWIASPECTS-DWI mismatch, using PWI-DWI mismatch as a reference. Correlations were calculated between the mismatches, as well as between SWI-volume and time-to-maximum (Tmax) > 6 s volume. Additionally, each of these mismatches was correlated with the National Institute of Health Stroke Scale (NIHSS).

Results: The sensitivity, negative predictive value, and accuracy of SWIvolume-DWI mismatch were demonstrably higher than SWIASPECTS-DWI mismatch (100% vs. 53.7%, 100% vs. 9.5%, 97.7% vs. 54.5%, respectively). A significant positive correlation was found between SWIvolume-DWI and PWI-DWI mismatch (r = 0.691, p < 0.01), as well as between SWI-volume and Tmax > 6 s volume (r = 0.786, p < 0.001). A significant negative correlation was found between SWIvolume-DWI mismatch and NIHSS (r = - 0.360, p = 0.022), as well as between SWIASPECTS-DWI mismatch and NIHSS (r = - 0.499, p = 0.001).

Conclusions: SWIvolume-DWI mismatch had higher diagnostic efficacy than SWIASPECTS-DWI mismatch in defining the ischemic penumbra and showed good consistency with PWI-DWI mismatch in acute ischemic stroke. Quantitation of APCVs using SWIM provided an accurate method for determining hypoperfusion and provided a reliable method to reflect the hypoxia of penumbra.

Key points: • SWIvolume-DWI mismatch has higher diagnostic efficacy than SWIASPECTS-DWI mismatch in defining the ischemic penumbra. • SWIvolume-DWI mismatch shows good consistency with PWI-DWI mismatch in managing penumbra in acute ischemic stroke. • Quantitation of APCV volume using SWIM provided an accurate method for determining the hypoperfusion area and provided a reliable method to reflect the hypoxia of penumbra.

Keywords: Hypoxia; Magnetic resonance imaging; Stroke.

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References

    1. Copen WA, Schaefer PW, Wu O (2011) MR perfusion imaging in acute ischemic stroke. Neuroimaging Clin N Am 21:259–283, x - PubMed - PMC
    1. Wintermark M, Sanelli PC, Albers GW et al (2013) Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol 34:E117–E127 - PubMed - PMC
    1. Schlaug G, Benfield A, Baird AE et al (1999) The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 53:1528–1537 - PubMed
    1. Albers GW, Thijs VN, Wechsler L et al (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 60:508–517 - PubMed
    1. Hjort N, Butcher K, Davis SM et al (2005) Magnetic resonance imaging criteria for thrombolysis in acute cerebral infarct. Stroke 36:388–397 - PubMed

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