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Improving the prediction of final infarct size in acute stroke with bolus delay–corrected perfusion MRI measures
Author(s) -
Rose Stephen E.,
Janke Andrew L.,
Griffin Mark,
Strudwick Mark W.,
Finnigan Simon,
Semple James,
Chalk Jonathan B.
Publication year - 2004
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.20216
Subject(s) - medicine , perfusion , nuclear medicine , bolus (digestion) , perfusion scanning , correlation , cerebral blood flow , effective diffusion coefficient , magnetic resonance imaging , diffusion mri , cardiology , radiology , mathematics , geometry
Purpose To investigate whether bolus delay‐corrected dynamic susceptibility contrast (DSC) perfusion MRI measures allowed a more accurate estimation of eventual infarct volume in 14 acute stroke patients using a predictive tissue classifier algorithm. Materials and Methods Tissue classification was performed using a expectation maximization and k ‐means clustering algorithm utilizing diffusion and T2 measures (diffusion‐weighted imaging [DWI], apparent diffusion coefficient [ADC], and T2) combined with uncorrected perfusion measures cerebral blood flow ((CBF) and mean transit time [MTT]), bolus delay–corrected perfusion measures (cCBF and cMTT), and bolus delay–corrected perfusion indices (cCBF and cMTT with bolus delay). Results The mean similarity index (SI), a kappa‐based correlation statistic reflecting the pixel‐by‐pixel classification agreement between predicted and 30‐day T2 lesion volumes, were 0.55 ± 0.19, 0.61 ± 0.15 ( P < 0.02) and 0.60 ± 0.17 ( P <0.03), respectively. Spearman's correlation coefficients, comparing predicted and final lesion volumes were 0.56 ( P < 0.05), 0.70 ( P < 0.01), and 0.84 ( P < 0.001), respectively. We found a more significant correlation between predicted infarct volumes derived from bolus delay–corrected perfusion measures than from conventional perfusion measures when combined with diffusion measures and compared with final lesion volumes measured on 30‐day T2 MRI scans. Conclusion Bolus delay–corrected perfusion measures enable an improved prediction of infarct evolution and evaluation of the hemodynamic status of neuronal tissue in acute stroke. J. Magn. Reson. Imaging 2004;20:941–947. © 2004 Wiley‐Liss, Inc.