Does the acute diffusion-weighted imaging lesion represent penumbra as well as core? A combined quantitative PET/MRI voxel-based study.
In acute ischemic stroke, the diffusion-weighted imaging (DWI) lesion is widely held to represent the core of irreversible damage and is therefore crucial in selecting patients for thrombolysis. However, recent research suggests it may also represent penumbra. An illustrative patient was imaged 7 hours after stroke onset with back-to-back 3T diffusion tensor imaging and quantitative positron emission tomography, which showed a DWI lesion and misery perfusion, respectively. Using previously validated voxel-based probabilistic CBF, CMRO2, and Oxygen Extraction Fraction (OEF) thresholds, the authors show that the DWI lesion contained not only core but also substantial proportions of penumbra. Also, severe apparent diffusion coefficient reductions were present within the potentially salvageable penumbra as well as in the core. These findings have potential implications regarding treatment decisions.
Guadagno
Joseph V
JV
Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 2QQ, UK.
Warburton
Elizabeth A
EA
Aigbirhio
Franklin I
FI
Smielewski
Piotr
P
Fryer
Tim D
TD
Harding
Sally
S
Price
Christopher J
CJ
Gillard
Jonathan H
JH
Carpenter
T Adrian
TA
Baron
Jean-Claude
JC
D002545:Brain Ischemia / Q000473:pathology*; D004058:Diffusion; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D013997:Time Factors