title: Does the acute diffusion-weighted imaging lesion represent penumbra as well as core? A combined quantitative PET/MRI voxel-based study.
abstract: 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.
authors.affiliation: Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 2QQ, UK.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Guadagno
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
authors.forename: Franklin I
authors.initials: FI
authors.lastname: Aigbirhio
authors.forename: Piotr
authors.initials: P
authors.lastname: Smielewski
authors.forename: Tim D
authors.initials: TD
authors.lastname: Fryer
authors.forename: Sally
authors.initials: S
authors.lastname: Harding
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Price
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Gillard
authors.forename: T Adrian
authors.initials: TA
authors.lastname: Carpenter
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
mesh_terms: 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