Defining the Ischemic Penumbra Using Hyperacute Neuroimaging: Deriving Quantitative Ischemic Thresholds

Translational Stroke Research

Volumn 3, Issue 2, 2012, Pages 198-204

  Ford, Andria L ^a   An, Hongyu ^b   Vo, Katie D ^c   Lin, Weili ^b   Lee, Jin Moo ^a,c  

^a WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF NORTH CAROLINA SCHOOL OF MEDICINE   (United States)

^c WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Acute ischemic stroke; Ischemic penumbra; Magnetic resonance imaging; MRI; Neuroimaging; Reperfusion; Threshold

Indexed keywords

ALTEPLASE; FLUMAZENIL C 11; SARUPLASE;

BRAIN BLOOD FLOW; BRAIN INJURY; BRAIN ISCHEMIA; BRAIN SCINTISCANNING; COMPUTER ASSISTED TOMOGRAPHY; DIFFUSION WEIGHTED IMAGING; DISEASE MARKER; FIBRINOLYTIC THERAPY; HUMAN; IMAGE ANALYSIS; ISCHEMIC PENUMBRA; NEUROIMAGING; NONHUMAN; PERFUSION WEIGHTED IMAGING; POSITRON EMISSION TOMOGRAPHY; PRIORITY JOURNAL; QUANTITATIVE ANALYSIS; REPERFUSION; REVIEW; STROKE;

EID: 84861675228     PISSN: 18684483     EISSN: 1868601X     Source Type: Journal    
DOI: 10.1007/s12975-012-0181-x     Document Type: Review

References (51)

1. Astrup J, Symon L, Branston NM, Lassen NA. Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke. 1977; 8: 51-7.
2. Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg. 1981; 54: 773-82.
3. Heiss WD, Rosner G. Functional recovery of cortical neurons as related to degree and duration of ischemia. Ann Neurol. 1983; 14: 294-301.
4. Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia-the ischemic penumbra. Stroke. 1981; 12: 723-5.
5. Astrup J. Energy-requiring cell functions in the ischemic brain. Their critical supply and possible inhibition in protective therapy. J Neurosurg. 1982; 56: 482-97.
6. Tissue plasminogen activator for acute ischemic stroke. The National Institute Of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995; 333: 1581-1587.
7. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke. N Engl J Med. 2008; 359: 1317-29.
8. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999; 282: 2003-11.
9. Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010; 375: 1695-703.
10. Fisher M. New approaches to neuroprotective drug development. Stroke. 2011; 42: S24-7.
11. Powers WJ. Imaging preventable infarction in patients with acute ischemic stroke. AJNR Am J Neuroradiol. 2008; 29: 1823-5.
12. Baron JC, Rougemont D, Lebrun-Grandie P. Measurement of local blood flow and oxygen consumption in evolving irreversible cerebral infarction: an in vivo study in man. In: Meyer JS, Lechner H, Reivich M, editors. Cerebral vascular disease. Princeton: Excerpta Medica; 1983. p. 205-12.
13. Powers WJ. Positron emission tomography in cerebrovascular disease: clinical applications? In: Theodore WH, editor. Clinical neuroimaging (frontiers of clinical neuroscience series). New York: Alan R. Liss; 1988. p. 49-74.
14. Powers WJ, Grubb Jr RL, Darriet D, Raichle ME. Cerebral blood flow and cerebral metabolic rate of oxygen requirements for cerebral function and viability in humans. J Cereb Blood Flow Metab. 1985; 5: 600-8.
15. Baron JC, Bousser MG, Comar D, Soussaline F, Castaigne P. Noninvasive tomographic study of cerebral blood flow and oxygen metabolism in vivo. Potentials, limitations, and clinical applications in cerebral ischemic disorders. Eur Neurol. 1981; 20: 273-84.
16. Wise RJ, Bernardi S, Frackowiak RS, Legg NJ, Jones T. Serial observations on the pathophysiology of acute stroke. The transition from ischaemia to infarction as reflected in regional oxygen extraction. Brain. 1983; 106(Pt 1): 197-222.
17. Touzani O, Young AR, Derlon JM, Baron JC, MacKenzie ET. Progressive impairment of brain oxidative metabolism reversed by reperfusion following middle cerebral artery occlusion in anaesthetized baboons. Brain Res. 1997; 767: 17-25.
18. Leblanc R. Physiologic studies of cerebral ischemia. Clin Neurosurg. 1991; 37: 289-311.
19. Baron JC, Marchal G. How time dependent is the threshold for cerebral infarction? Stroke. 1996; 27: 1918-9.
20. Heiss WD, Graf R, Fujita T, Ohta K, Bauer B, Lottgen J, et al. Early detection of irreversibly damaged ischemic tissue by flumazenil positron emission tomography in cats. Stroke. 1997; 28: 2045-51. discussion 2051-2042.
21. Heiss WD, Kracht LW, Thiel A, Grond M, Pawlik G. Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia. Brain. 2001; 124: 20-9.
22. Heiss WD, Sobesky J, Smekal U, Kracht LW, Lehnhardt FG, Thiel A, et al. Probability of cortical infarction predicted by flumazenil binding and diffusion-weighted imaging signal intensity: a comparative positron emission tomography/magnetic resonance imaging study in early ischemic stroke. Stroke. 2004; 35: 1892-8.
23. Rohl L, Ostergaard L, Simonsen CZ, Vestergaard-Poulsen P, Andersen G, Sakoh M, et al. Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke. 2001; 32: 1140-6.
24. Neumann-Haefelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz RJ, Modder U, et al. Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke. 1999; 30: 1591-7.
25. Schwamm LH, Koroshetz WJ, Sorensen AG, Wang B, Copen WA, Budzik R, et al. Time course of lesion development in patients with acute stroke: serial diffusion- and hemodynamic-weighted magnetic resonance imaging. Stroke. 1998; 29: 2268-76.
26. Baird AE, Benfield A, Schlaug G, Siewert B, Lovblad KO, Edelman RR, et al. Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol. 1997; 41: 581-9.
27. Kidwell CS, Saver JL, Mattiello J, Starkman S, Vinuela F, Duckwiler G, et al. Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol. 2000; 47: 462-9.
28. Fiehler J, Foth M, Kucinski T, Knab R, von Bezold M, Weiller C, et al. Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke. 2002; 33: 79-86.
29. Takasawa M, Jones PS, Guadagno JV, Christensen S, Fryer TD, Harding S, et al. How reliable is perfusion MR in acute stroke? Validation and determination of the penumbra threshold against quantitative PET. Stroke. 2008; 39: 870-7.
30. Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, et al. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol. 2002; 51: 417-32.
31. Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006; 37: 979-85.
32. Mayer TE, Hamann GF, Baranczyk J, Rosengarten B, Klotz E, Wiesmann M, et al. Dynamic ct perfusion imaging of acute stroke. AJNR Am J Neuroradiol. 2000; 21: 1441-9.
33. Bivard A, McElduff P, Spratt N, Levi C, Parsons M. Defining the extent of irreversible brain ischemia using perfusion computed tomography. Cerebrovasc Dis. 2011; 31: 238-45.
34. Campbell B, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW. Predicting infarct core using ct perfusion: Comparison of CT perfusion parameters to concurrent diffusion MRI. International Stroke Conference. 2011.
35. Lee JM, Vo KD, An H, Celik A, Lee Y, Hsu CY, et al. Magnetic resonance cerebral metabolic rate of oxygen utilization in hyperacute stroke patients. Ann Neurol. 2003; 53: 227-32.
36. Lu H, Xu F, Grgac K, Liu P, Qin Q, van Zijl P. Calibration and validation of TRUST MRI for the estimation of cerebral blood oxygenation. Magn Reson Med. 2012; 67: 42-9.
37. An H, Liu Q, Chen Y, Lin W. Evaluation of MR-derived cerebral oxygen metabolic index in experimental hyperoxic hypercapnia, hypoxia, and ischemia. Stroke. 2009; 40: 2165-72.
38. Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. 2009; 73: 1066-72.
39. Fluss R, Faraggi D, Reiser B. Estimation of the Youden index and its associated cutoff point. Biom J. 2005; 47: 458-72.
40. Shen Q, Ren H, Fisher M, Duong TQ. Statistical prediction of tissue fate in acute ischemic brain injury. J Cereb Blood Flow Metab. 2005; 25: 1336-45.
41. Jacobs MA, Knight RA, Soltanian-Zadeh H, Zheng ZG, Goussev AV, Peck DJ, et al. Unsupervised segmentation of multiparameter MRI in experimental cerebral ischemia with comparison to T2, diffusion, and ADC MRI parameters and histopathological validation. J Magn Reson Imaging. 2000; 11: 425-37.
42. Wu O, Sumii T, Asahi M, Sasamata M, Ostergaard L, Rosen BR, et al. Infarct prediction and treatment assessment with MRI-based algorithms in experimental stroke models. J Cereb Blood Flow Metab. 2007; 27: 196-204.
43. Wu O, Christensen S, Hjort N, Dijkhuizen RM, Kucinski T, Fiehler J, et al. Characterizing physiological heterogeneity of infarction risk in acute human ischaemic stroke using MRI. Brain. 2006; 129: 2384-93.
44. Hacke W, Albers G, Al-Rawi Y, Bogousslavsky J, Davalos A, Eliasziw M, et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke. 2005; 36: 66-73.
45. Furlan AJ, Eyding D, Albers GW, Al-Rawi Y, Lees KR, Rowley HA, et al. Dose Escalation of Desmoteplase for Acute Ischemic Stroke (DEDAS): evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke. 2006; 37: 1227-31.
46. Hacke W, Furlan AJ, Al-Rawi Y, Davalos A, Fiebach JB, Gruber F, et al. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion ct (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol. 2009; 8: 141-50.
47. Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol. 2006; 60: 508-17.
48. Albers GW. Results of DEFUSE 2: imaging endpoints. International Stroke Conference. 2012.
49. Lansberg MG. Results of DEFUSE 2: clinical endpoints. International Stroke Conference. 2012.
50. Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol. 2008; 7: 299-309.
51. Davis SM, Donnan GA, Butcher KS, Parsons M. Selection of thrombolytic therapy beyond 3 h using magnetic resonance imaging. Curr Opin Neurol. 2005; 18: 47-52.