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A PET‐Guided Framework Supports a Multiple Arterial Input Functions Approach in DSC‐MRI in Acute Stroke
Author(s) -
Livne Michelle,
Madai Vince I.,
Brunecker Peter,
ZaroWeber Olivier,
MoellerHartmann Walter,
Heiss WolfDieter,
Mouridsen Kim,
Sobesky Jan
Publication year - 2017
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12428
Subject(s) - medicine , receiver operating characteristic , voxel , nuclear medicine , magnetic resonance imaging , acute stroke , stroke (engine) , positron emission tomography , perfusion scanning , radiology , perfusion , mechanical engineering , tissue plasminogen activator , engineering
BACKGROUND AND PURPOSE In acute stroke, arterial‐input‐function (AIF) determination is essential for obtaining perfusion estimates with dynamic susceptibility‐weighted contrast‐enhanced magnetic resonance imaging (DSC‐MRI). Standard DSC‐MRI postprocessing applies single AIF selection, ie, global AIF. Physiological considerations, however, suggest that a multiple AIFs selection method would improve perfusion estimates to detect penumbral flow. In this study, we developed a framework based on comparable DSC‐MRI and positron emission tomography (PET) images to compare the two AIF selection approaches and assess their performance in penumbral flow detection in acute stroke. METHODS In a retrospective analysis of 17 sub(acute) stroke patients with consecutive MRI and PET scans, voxel‐wise optimized AIFs were calculated based on the kinetic model as derived from both imaging modalities. Perfusion maps were calculated based on the optimized‐AIF using two methodologies: (1) Global AIF and (2) multiple AIFs as identified by cluster analysis. Performance of penumbral‐flow detection was tested by receiver–operating characteristics (ROC) curve analysis, ie, the area under the curve (AUC). RESULTS Large variation of optimized AIFs across brain voxels demonstrated that there is no optimal single AIF. Subsequently, the multiple‐AIF method (AUC range over all maps: .82‐.90) outperformed the global AIF methodology (AUC .72‐.85) significantly. CONCLUSIONS We provide PET imaging‐based evidence that a multiple AIF methodology is beneficial for penumbral flow detection in comparison with the standard global AIF methodology in acute stroke.