title: Relationship Between Changes in the Temporal Dynamics of the Blood-Oxygen-Level-Dependent Signal and Hypoperfusion in Acute Ischemic Stroke.
abstract: Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in stroke patients.
  
  
  
  In 30 patients with acute (<24 hours) ischemic stroke, we performed Pearson correlation and multiple linear regression between DSC-MRI parameters (time to maximum [Tmax], mean transit time, cerebral blood flow, and cerebral blood volume) and BOLD-based parameters (BOLD delay and coefficient of BOLD variation). Prediction of severe hypoperfusion (Tmax >6 seconds) was assessed using receiver-operator characteristic (ROC) analysis.
  
  
  
  Correlation was highest between Tmax and BOLD delay (venous sinus reference; time shift range 7; medianr=0.60; interquartile range=0.49-0.71). Coefficient of BOLD variation correlated with cerebral blood volume (medianr= 0.37; interquartile range=0.24-0.51). MeanR2for predicting BOLD delay by DSC-MRI was 0.54 (SD=0.2) and for predicting coefficient of BOLD variation was 0.37 (SD=0.17). BOLD delay (whole-brain reference, time shift range 3) had an area under the curve of 0.76 for predicting severe hypoperfusion (sensitivity=69.2%; specificity=80%), whereas BOLD delay (venous sinus reference, time shift range 3) had an area under the curve of 0.76 (sensitivity=67.3%; specificity=83.5%).
  
  
  
  BOLD delay is related to macrovascular delay and microvascular hypoperfusion, can identify severely hypoperfused tissue in acute stroke, and is a promising alternative to gadolinium contrast agent-based perfusion assessment in acute stroke.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00715533 and NCT02077582.
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.). ahmed-abdelrahim.khalil@charite.de.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khalil
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Ostwaldt
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Till
authors.initials: T
authors.lastname: Nierhaus
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Ramanan
authors.initials: R
authors.lastname: Ganeshan
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Arno
authors.initials: A
authors.lastname: Villringer
authors.affiliation: From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (A.A.K., A.-C.O., R.G., H.J.A., K.V., J.B.F.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (A.A.K., T.N., A.V.); Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-University, Berlin, Germany (A.A.K., A.V.); and Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Germany (T.N.).
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging*; D013997:Time Factors
keywords: BOLD delay; blood volume; brain; gadolinium; perfusion imaging; stroke