title: The potential of microvessel density in prediction of infarct growth: a two-month experimental study in vessel size imaging.
abstract: OBJECTIVE
  Vessel size imaging is a novel technique to evaluate pathological changes of the microvessel density quantity Q and the mean vessel size index (VSI). As a follow-up study, we assessed these parameters for microscopic description of ischemic penumbra and their potentials in predicting lesion growth.
  
  
  METHODS
  Seventy-five patients with a perfusion-diffusion mismatch were examined within 24 h from symptom onset. We defined three regions of interest: the initial infarct (INF), the ischemic penumbra (IPE), and the healthy region (HEA) symmetric to the IPE. For 23 patients with a 6th-day follow-up, IPE regions were divided into areas of infarct growth and areas of oligemia.
  
  
  RESULTS
  The median values of Q and VSI were: for INF 0.29 s(-1/3) and 15.8 μm, for IPE 0.33 s(-1/3) and 20.6 μm and for HEA 0.36 s(-1/3) and 17.4 μm. The Q in the IPE was significantly smaller than in HEA, and VSI was significantly larger. The Q with a threshold of 0.32 s(-1/3) predicted the final infarction with a sensitivity of 69% and a specificity of 64%.
  
  
  CONCLUSIONS
  The reduced Q and increased VSI in the IPE confirmed our previous pilot results. Although Q showed a trend to identify the severity of ischemia in an overall voxel population, its potential in predicting infarct growth needs to be further tested in a larger cohort including a clear status of reperfusion and recanalization.
authors.affiliation: Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. chao.xu@charite.de
authors.forename: Chao
authors.initials: C
authors.lastname: Xu
authors.forename: Wolf U H
authors.initials: WU
authors.lastname: Schmidt
authors.forename: Ivana
authors.initials: I
authors.lastname: Galinovic
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hotter
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Ostwaldt
authors.forename: Natalia
authors.initials: N
authors.lastname: Denisova
authors.forename: Elias
authors.initials: E
authors.lastname: Kellner
authors.forename: Valerij
authors.initials: V
authors.lastname: Kiselev
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001776:Blood Circulation Time; D002544:Cerebral Infarction / Q000473:pathology*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015427:Reperfusion Injury / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator