Universität zu Köln

Zaro-Weber, Olivier, Fleischer, Hermann, Reiblich, Lucas, Schuster, Alexander, Moeller-Hartmann, Walter and Heiss, Wolf-Dieter (2019). Penumbra detection in acute stroke with perfusion magnetic resonance imaging: Validation with O-15-positron emission tomography. Ann. Neurol., 85 (6). S. 875 - 887. HOBOKEN: WILEY. ISSN 1531-8249

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Abstract

Objective Accurate identification of the ischemic penumbra, the therapeutic target in acute clinical stroke, is of critical importance to identify patients who might benefit from reperfusion therapies beyond the established time windows. Therefore, we aimed to validate magnetic resonance imaging (MRI) mismatch-based penumbra detection against full quantitative positron emission tomography (O-15-PET), the gold standard for penumbra detection in acute ischemic stroke. Methods Ten patients (group A) with acute and subacute ischemic stroke underwent perfusion-weighted (PW)/diffusion-weighted MRI and consecutive full quantitative O-15-PET within 48 hours of stroke onset. Penumbra as defined by O-15-PET cerebral blood flow (CBF), oxygen extraction fraction, and oxygen metabolism was used to validate a wide range of established PW measures (eg, time-to-maximum [Tmax]) to optimize penumbral tissue detection. Validation was carried out using a voxel-based receiver-operating-characteristic curve analysis. The same validation based on penumbra as defined by quantitative O-15-PET CBF was performed for comparative reasons in 23 patients measured within 48 hours of stroke onset (group B). Results The PW map Tmax (area-under-the-curve = 0.88) performed best in detecting penumbral tissue up to 48 hours after stroke onset. The optimal threshold to discriminate penumbra from oligemia was Tmax >5.6 seconds with a sensitivity and specificity of >80%. Interpretation The performance of the best PW measure Tmax to detect the upper penumbral flow threshold in ischemic stroke is excellent. Tmax >5.6 seconds-based penumbra detection is reliable to guide treatment decisions up to 48 hours after stroke onset and might help to expand reperfusion treatment beyond the current time windows. ANN NEUROL 2019;85:875-886.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zaro-Weber, Olivier UNSPECIFIED UNSPECIFIED UNSPECIFIED Fleischer, Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Reiblich, Lucas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schuster, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Moeller-Hartmann, Walter UNSPECIFIED UNSPECIFIED UNSPECIFIED Heiss, Wolf-Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-147129
DOI:	10.1002/ana.25479
Journal or Publication Title:	Ann. Neurol.
Volume:	85
Number:	6
Page Range:	S. 875 - 887
Date:	2019
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1531-8249
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CEREBRAL-BLOOD-FLOW; ISCHEMIC PENUMBRA; HYPERACUTE STROKE; OXYGEN-METABOLISM; WEIGHTED MRI; VIABILITY THRESHOLDS; DIFFUSION; PET; TISSUE; CT Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14712