title: A PET-Guided Framework Supports a Multiple Arterial Input Functions Approach in DSC-MRI in Acute Stroke.
abstract: In acute stroke, arterial-input-function (AIF) determination is essential for obtaining perfusion estimates with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI). Standard DSC-MRI postprocessing applies single AIF selection, ie, global AIF. Physiological considerations, however, suggest that a multiple AIFs selection method would improve perfusion estimates to detect penumbral flow. In this study, we developed a framework based on comparable DSC-MRI and positron emission tomography (PET) images to compare the two AIF selection approaches and assess their performance in penumbral flow detection in acute stroke.
  
  
  
  In a retrospective analysis of 17 sub(acute) stroke patients with consecutive MRI and PET scans, voxel-wise optimized AIFs were calculated based on the kinetic model as derived from both imaging modalities. Perfusion maps were calculated based on the optimized-AIF using two methodologies: (1) Global AIF and (2) multiple AIFs as identified by cluster analysis. Performance of penumbral-flow detection was tested by receiver-operating characteristics (ROC) curve analysis, ie, the area under the curve (AUC).
  
  
  
  Large variation of optimized AIFs across brain voxels demonstrated that there is no optimal single AIF. Subsequently, the multiple-AIF method (AUC range over all maps: .82-.90) outperformed the global AIF methodology (AUC .72-.85) significantly.
  
  
  
  We provide PET imaging-based evidence that a multiple AIF methodology is beneficial for penumbral flow detection in comparison with the standard global AIF methodology in acute stroke.
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Michelle
authors.initials: M
authors.lastname: Livne
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Vince I
authors.initials: VI
authors.lastname: Madai
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Brunecker
authors.affiliation: Max-Planck-Institute for Neurological Research, Cologne, Germany.
authors.forename: Olivier
authors.initials: O
authors.lastname: Zaro-Weber
authors.affiliation: Department of Radiology, Ludmillenstift Meppen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Moeller-Hartmann
authors.affiliation: Max-Planck-Institute for Neurological Research, Cologne, Germany.
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Heiss
authors.affiliation: Center of Functionally Integrative Neuroscience, Aarhus University, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Mouridsen
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Sobesky
mesh_terms: D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging*
keywords: Arterial input function; DSC-MRI; PET; PWI; local AIF