Brain, Vol. 122, No. 12, 2387-2400,
December 1999
© 1999 Oxford University Press
Review article |
Voxel-based mapping of irreversible ischaemic damage with PET in acute stroke
1 INSERM U320, 2 CYCERON, 3 University Hospital, University of Caen, Caen, France
Correspondence to:
Dr Jean-Claude Baron, INSERM U320, CYCERON, Bd Becquerel, BP 5229, 14074 Caen, France E-mail: baron{at}cyceron.fr
Objective mapping of irreversible tissue damage in the acute stage of ischaemic stroke would be useful for prognosis and in assessing the efficacy of therapeutic manoeuvres in impeding extension of infarction. From our database of 30 patients studied with 15O-PET within 5–18 h after onset of first-ever middle cerebral artery territory stroke, we extracted a subgroup of 19 survivors (age 74.6 ± 8.5 years) in whom late CT coregistered with PET was available to determine final infarct topography. By means of a voxel-based analysis of the PET data, we determined putative thresholds for irreversible tissue damage as the lower limit of the 95% confidence interval calculated from all voxels within the ultimately non-infarcted brain parenchyma ipsilateral to the insult. The following values were found: 8.43 ml/100 ml/min, 0.87 ml/100 ml/min, 1.64 ml/100 ml, 0.27 and 2.21/min, for cerebral blood flow (CBF), oxygen consumption (CMRO2), blood volume (CBV), oxygen extraction fraction and the ratio CBF : CBV, respectively. Voxels below these thresholds occurred significantly more frequently in the final infarct region than in the non-infarcted parenchyma for CBF and CMRO2 (P = 0.016 and P = 0.0045, respectively, Wilcoxon test), but not for the other PET variables. Furthermore, with both CBF and CMRO2, the percentage of irreversible tissue damage voxels in the affected hemisphere relative to the opposite hemisphere was significantly positively correlated to both the volume of final infarct and the neurological outcome at 2 months (all P < 0.005, Spearman ranked test). These findings validate our voxel-based CBF and CMRO2 thresholds for probabilistic mapping of irreversible tissue damage within the 5–18 h interval after stroke onset; however, whether they would be applicable to earlier intervals remains to be determined. Transfer of our procedure for determination of irreversible tissue damage thresholds to other imaging modalities such as single proton emission computed tomography and diffusion-weighted MRI should be straightforward.
stroke; cerebral blood flow; oxygen metabolism; PET
GI = glabella–inion; MCA = middle cerebral artery; NIBP = non-infarcted brain parenchyma; CBF = regional cerebral blood flow; CMRO2 = regional cerebral oxygen consumption; OEF = regional oxygen extraction fraction; ROI = region of interest
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. D. Murphy, A. J. Fox, D. H. Lee, D. J. Sahlas, S. E. Black, M. J. Hogan, S. B. Coutts, A. M. Demchuk, M. Goyal, R. I. Aviv, et al. White Matter Thresholds for Ischemic Penumbra and Infarct Core in Patients with Acute Stroke: CT Perfusion Study Radiology, June 1, 2008; 247(3): 818 - 825. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. Tayal, R. Gupta, H. Yonas, T. Jovin, K. Uchino, M. Hammer, L. Wechsler, and J. M. Gebel Quantitative Perihematomal Blood Flow in Spontaneous Intracerebral Hemorrhage Predicts In-Hospital Functional Outcome Stroke, February 1, 2007; 38(2): 319 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. V. Guadagno, E. A. Warburton, P. S. Jones, D. J. Day, F. I. Aigbirhio, T. D. Fryer, S. Harding, C. J. Price, H. A. Green, O. Barret, et al. How affected is oxygen metabolism in DWI lesions?: A combined acute stroke PET-MR study. Neurology, September 12, 2006; 67(5): 824 - 829. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J.S. Price, D. Wang, D. K. Menon, J. V. Guadagno, M. Cleij, T. Fryer, F. Aigbirhio, J.-C. Baron, and E. A. Warburton Intrinsic Activated Microglia Map to the Peri-infarct Zone in the Subacute Phase of Ischemic Stroke Stroke, July 1, 2006; 37(7): 1749 - 1753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Guadagno, P. S. Jones, T. D. Fryer, O. Barret, F. I. Aigbirhio, T. A. Carpenter, C. J. Price, J. H. Gillard, E. A. Warburton, and J.-C. Baron Local Relationships Between Restricted Water Diffusion and Oxygen Consumption in the Ischemic Human Brain Stroke, July 1, 2006; 37(7): 1741 - 1748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bandera, M. Botteri, C. Minelli, A. Sutton, K. R. Abrams, and N. Latronico Cerebral Blood Flow Threshold of Ischemic Penumbra and Infarct Core in Acute Ischemic Stroke: A Systematic Review Stroke, May 1, 2006; 37(5): 1334 - 1339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Cunningham, R. Salvador, J. P. Coles, D. A. Chatfield, P. G. Bradley, A. J. Johnston, L. A. Steiner, T. D. Fryer, F. I. Aigbirhio, P. Smielewski, et al. Physiological thresholds for irreversible tissue damage in contusional regions following traumatic brain injury Brain, August 1, 2005; 128(8): 1931 - 1942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sobesky, O. Z. Weber, F.-G. Lehnhardt, V. Hesselmann, M. Neveling, A. Jacobs, and W.-D. Heiss Does the Mismatch Match the Penumbra?: Magnetic Resonance Imaging and Positron Emission Tomography in Early Ischemic Stroke Stroke, May 1, 2005; 36(5): 980 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Jovin, H. Yonas, J. M. Gebel, E. Kanal, Y. F. Chang, S. Z. Grahovac, S. Goldstein, and L. R. Wechsler The Cortical Ischemic Core and Not the Consistently Present Penumbra Is a Determinant of Clinical Outcome in Acute Middle Cerebral Artery Occlusion Stroke, October 1, 2003; 34(10): 2426 - 2433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L A Steiner, J P Coles, M Czosnyka, P S Minhas, T D Fryer, F I Aigbirhio, J C Clark, P Smielewski, D A Chatfield, T Donovan, et al. Cerebrovascular pressure reactivity is related to global cerebral oxygen metabolism after head injury J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 765 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. Shih, J. L. Saver, J. R. Alger, S. Starkman, M. C. Leary, F. Vinuela, G. Duckwiler, Y. P. Gobin, R. Jahan, J. P. Villablanca, et al. Perfusion-Weighted Magnetic Resonance Imaging Thresholds Identifying Core, Irreversibly Infarcted Tissue Stroke, June 1, 2003; 34(6): 1425 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Rohl, L. Ostergaard, C. Z. Simonsen, P. Vestergaard-Poulsen, G. Andersen, M. Sakoh, D. Le Bihan, and C. Gyldensted Viability Thresholds of Ischemic Penumbra of Hyperacute Stroke Defined by Perfusion-Weighted MRI and Apparent Diffusion Coefficient Stroke, May 1, 2001; 32(5): 1140 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Koenig, M. Kraus, C. Theek, E. Klotz, W. Gehlen, and L. Heuser Quantitative Assessment of the Ischemic Brain by Means of Perfusion-Related Parameters Derived From Perfusion CT Stroke, February 1, 2001; 32(2): 431 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Vajkoczy, P. Horn, C. Bauhuf, E. Munch, U. Hubner, D. Ing, C. Thome, C. Poeckler-Schoeninger, H. Roth, and P. Schmiedek Effect of Intra-Arterial Papaverine on Regional Cerebral Blood Flow in Hemodynamically Relevant Cerebral Vasospasm Stroke, February 1, 2001; 32(2): 498 - 505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-C. Baron Mapping the ischaemic penumbra with PET: a new approach Brain, January 1, 2001; 124(1): 2 - 4. [Full Text] [PDF]
|
|
|
|
|
|
W.-D. Heiss, L. W. Kracht, A. Thiel, M. Grond, and G. Pawlik Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia Brain, January 1, 2001; 124(1): 20 - 29. [Abstract] [Full Text] [PDF]
|
|