The existence and evolution of diffusion-perfusion mismatched tissue in white and gray matter after acute stroke.
OBJECTIVE
Although white matter is a potential target of acute stroke therapy, there is uncertainty about its relative resistance to ischemia and whether it is capable of mounting a penumbral response. To explore these issues further, we examined the differential effects of ischemia on gray and white matter using magnetic resonance (MR) perfusion-diffusion mismatch after acute stroke.


METHODS
MR imaging studies were performed within 12 hours in patients with initial hemispheric ischemic stroke. "At-risk" tissue was defined as tissue with abnormal diffusion-weighted imaging/perfusion-weight imaging or infarction on follow-up image. Tissue was segmented using a probabilistic atlas generated from age-matched controls. The proportions of "at-risk" tissue, which was penumbral at the time of imaging, were compared between gray and white matter.


RESULTS
Thirty-two patients had diffusion-perfusion mismatched penumbral tissue present in both gray and white matter compartments. Although the absolute mismatch volumes were greater in gray (median 42 cm3, interquartile range 18 to 70 cm3) than in white matter (39 cm3, 17 to 49 cm3; P<0.001), the proportion of "at-risk" tissue, which was penumbral at the time of imaging (median 3.7 hours, range 1.5 to 9.9 hours) was greater in white (69%, 49% to 86%) than gray matter (62%, 52% to 75%; P=0.026). However, the proportions spontaneously salvaged by 3 months were similar in both compartments.


CONCLUSIONS
These findings are consistent with white matter being able to mount an ischemic penumbral response in humans and being more resistant to cerebral ischemia than gray matter. They also raise the possibility that the therapeutic window is longer for white matter and may require alternative therapeutic strategies.
Koga
Masatoshi
M
National Stroke Research Institute, Melbourne, Australia.
Reutens
David C
DC
Wright
Peter
P
Phan
Thanh
T
Markus
Romesh
R
Pedreira
Bruno
B
Fitt
Greg
G
Lim
Indra
I
Donnan
Geoffrey A
GA
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology*; D016022:Case-Control Studies; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D019786:Gadolinium DTPA / Q000494:pharmacology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007511:Ischemia / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging; D018696:Neuroprotective Agents / Q000494:pharmacology; D010477:Perfusion; D011336:Probability; D015203:Reproducibility of Results; D012306:Risk; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D018696:Neuroprotective Agents; D019786:Gadolinium DTPA