A Method for Imaging the Ischemic Penumbra with MRI Using Intravoxel Incoherent Motion.

Mira M Liu, Niloufar Saadat, Steven P Roth, Marek A Niekrasz, Mihai Giurcanu, Mohammed Salman Shazeeb, Timothy J Carroll, Gregory A Christoforidis
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引用次数: 0

Abstract

Background and purpose: In acute ischemic stroke, the amount of "local" CBF distal to the occlusion, ie, all blood flow, whether supplied antegrade or delayed and dispersed through the collateral network, may contain valuable information regarding infarct growth rate and treatment response. DSC processed with a local arterial input function (AIF) is one method of measuring local CBF (local-qCBF) and has been shown to correlate with collateral supply. Similarly, intravoxel incoherent motion MRI (IVIM) is "local," with excitation and readout in the same plane, and a potential alternative way to measure local-qCBF. This work compares IVIM local-qCBF against DSC local-qCBF in the ischemic penumbra, compares the measurement of perfusion-diffusion mismatch (PWI/DWI), and examines if local-qCBF may improve prediction of the final infarct.

Materials and methods: Eight experiments in a preclinical canine model of middle cerebral artery occlusion were performed. Native collateral circulation was quantified via x-ray DSA 30 minutes postocclusion, and collateral supply was subsequently enhanced in a subset of experiments with simultaneous pressor and vasodilator. IVIM, DSC, and DWI MRI were acquired 2.5 hours postocclusion. IVIM was postprocessed to return local-qCBF from fD*, water transport time (WTT) from D*, diffusion from D, and the PWI/DWI mismatch. These were compared with DSC parameters processed first with a standard global-AIF and then with a local-AIF. These DSC parameters included time-to-maximum, local MTT, standard-qCBF, local-qCBF, and PWI/DWI mismatch. Infarct volume was measured with DWI at 2.5 hours and 4 hours postocclusion.

Results: Two and one-half hours postocclusion, IVIM local-qCBF in the noninfarcted ipsilateral territory correlated strongly with DSC local-qCBF ([Formula: see text]). Correlation was weaker between IVIM local-qCBF and DSC standard-qCBF ([Formula: see text]). DSC local-qCBF and IVIM local-qCBF in the noninfarcted ipsilateral territory both returned strong prediction of final infarct volume ([Formula: see text]). DSC standard-qCBF was a weaker predictor ([Formula: see text]). The hypoperfused lesion from DSC local-qCBF and from IVIM local-qCBF both predicted final infarct volume with good sensitivity and correlation ([Formula: see text]. The IVIM PWI/DWI ratio was correlated with infarct growth ([Formula: see text]), and WTT correlated with DSC MTT ([Formula: see text]).

Conclusions: Noncontrast IVIM measurement of local-qCBF and PWI/DWI mismatch may include collateral circulation and improve prediction of infarct growth.

一种基于IVIM的缺血性半暗带MRI成像方法。
背景和目的:在急性缺血性卒中中,闭塞远端“局部”CBF的量,即一个区域内的所有血流,无论是顺行还是延迟并通过侧支网络分散,可能包含有关梗死生长速度和治疗反应的有价值的信息。使用局部动脉输入函数(AIF)的DSC CBF是量化局部CBF (local- qcbf)的一种方法,并与抵押品相关。同样,体素内非相干运动MRI (IVIM)是“局部的”,激发和读出在同一平面上,是测量局部qcbf的潜在替代方法。本研究的目的是比较IVIM局部- qcbf和DSC局部- qcbf在缺血半暗区,比较灌注-扩散失配(PWI/DWI)的测量结果,并检查局部- qcbf是否可以改善对最终梗死的预测。材料与方法:建立犬大脑中动脉闭塞临床前模型;闭塞后30分钟通过x线DSA量化天然侧支循环,随后在同时使用加压剂和血管扩张剂的实验中,侧支循环增强。阻断后2.5小时进行IVIM和DSC MRI检查。对IVIM进行后处理,从fD*返回local-qCBF,从D*返回水输运时间(WTT),从D返回扩散,以及PWI/DWI不匹配。将这些参数与DSC参数进行比较,DSC参数首先用标准的全局aif处理,然后用局部aif处理。这些DSC参数包括最大时间、本地MTT、标准qcbf、本地qcbf和PWI/DWI不匹配。闭塞后2.5小时和4小时用DWI测量梗死体积。结果:闭塞后2.5小时,同侧非梗死区域IVIM local-qCBF与DSC local-qCBF呈正相关(斜率=1.00,R2=0.69, Lin’s CCC=0.71)。IVIM local-qCBF与DSC standard-qCBF相关性较弱(R2=0.13)。同侧非梗死区域的DSC localqCBF和IVIM local-qCBF均能预测最终梗死体积(R2=0.78, R2=0.61)。DSC标准- qcbf是较弱的预测因子(R2=0.12)。DSC局部- qcbf和IVIM局部- qcbf的低灌注病灶预测最终梗死体积均具有良好的敏感性和相关性(斜率分别为2.08,R2=0.67,斜率为2.50,R2=0.68)。IVIM PWI/DWI比值与梗死面积相关(R2=0.70), WTT与DSC MTT相关(R2=0.60)。结论:非对比IVIM测量局部qcbf和PWI/DWI不匹配可能包括侧支循环和改善预测梗死生长。缩写:AIF:动脉输入功能,IVIM:体内不相干运动,qCBF:定量脑血流量,WTT:水运输时间,MCAO:大脑中动脉闭塞,MD:平均弥漫性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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