title: A novel method to derive separate gray and white matter cerebral blood flow measures from MR imaging of acute ischemic stroke patients.
abstract: Perfusion-weighted imaging (PWI) measures can predict tissue outcome in acute ischemic stroke. Accuracy might be improved if differential tissue susceptibility to ischemia is considered. We present a novel voxel-by-voxel analysis to characterize cerebral blood flow (CBF) separately in gray (GM) and white matter (WM). Ten patients were scanned with inversion-recovery spin-echo EPI (IRSEPI), diffusion-weighted imaging (DWI), PWI<6 h from onset and fluid attenuated inversion-recovery (FLAIR) at 30 days. Image processing included coregistration to PWI, automatic segmentation of IRSEPI into GM, WM and CSF and semiautomatic segmentation of DWI/FLAIR to derive the acute and 30-day lesions. Five tissue compartments were defined: (1) 'Core' (abnormal acutely and at 30 days), (2) 'Growth' (or 'infarcted penumbra', abnormal only at 30 days), (3) 'Reversed' (abnormal acutely but normal at 30 days), (4) 'MTT-Delayed ' (tissue with delayed mean transit time but not part of the acute or 30-day lesion), and (5) 'Normal' brain. Cerebral blood flow in GM and WM of each compartment was obtained from quantitative maps. Gray matter and WM mean CBF in the growth region differed by 5.5 mL/100 g min (P=0.015). Mean CBF also differed significantly within normal and MTT-Delayed compartments. The difference in the reversed region approached statistical significance. In core, GM and WM CBF did not differ. The results suggest separate ischemic thresholds for GM and WM in stroke penumbra.
authors.affiliation: [1] 1Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada [2] 2Seaman Family MR Research Centre, Foothills Medical Centre, Calgary Health Region, Calgary, Alberta, Canada.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Simon
authors.forename: Michael S
authors.initials: MS
authors.lastname: Bristow
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.forename: M Louis
authors.initials: ML
authors.lastname: Lauzon
authors.forename: Robert A
authors.initials: RA
authors.lastname: Brown
authors.forename: José V
authors.initials: JV
authors.lastname: Manjón
authors.forename: Michael
authors.initials: M
authors.lastname: Eliasziw
authors.forename: Richard
authors.initials: R
authors.lastname: Frayne
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Buchan
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: J Ross
authors.initials: JR
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013064:Speech Disorders / Q000209:etiology / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000473:pathology* / Q000503:physiopathology