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Neurology. 2019 May 21;92(21):e2462-e2471. doi: 10.1212/WNL.0000000000007538. Epub 2019 Apr 24.

Collateral blood flow measurement with intravoxel incoherent motion perfusion imaging in hyperacute brain stroke.

Author information

1
From the Department of Neuroradiology (C.F., M.W., D.G.M., G.Z., B.W.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, Stanford University, CA; Institute for Biomedical Engineering (C.F.), ETH Zürich and University of Zürich; and Department of Radiology, University Hospital Basel and University of Basel (C.F.), Switzerland. federau@biomed.ee.ethz.ch.
2
From the Department of Neuroradiology (C.F., M.W., D.G.M., G.Z., B.W.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, Stanford University, CA; Institute for Biomedical Engineering (C.F.), ETH Zürich and University of Zürich; and Department of Radiology, University Hospital Basel and University of Basel (C.F.), Switzerland.

Abstract

OBJECTIVE:

To determine if intravoxel incoherent motion (IVIM) magnetic resonance perfusion can measure the quality of the collateral blood flow in the penumbra in hyperacute stroke.

METHODS:

A 6 b values IVIM MRI sequence was acquired in stroke patients with large vessel occlusion imaged <16 hours of last seen well. IVIM perfusion measures were evaluated in regions of interest drawn in the infarct core (D < 600 mm2/s), in the corresponding region in the contralateral hemisphere, and in the dynamic susceptibility contrast penumbra. In patients with a penumbra >15 mL, images were reviewed for the presence of a penumbra perfusion lesion on the IVIM f map, which was correlated with infarct size metrics. Statistical significance was tested using Student t test, Mann-Whitney U test, and Fisher exact test.

RESULTS:

A total of 34 patients were included. In the stroke core, IVIM f was significantly lower (4.6 ± 3.3%) compared to the healthy contralateral region (6.3 ± 2.2%, p < 0.001). In the 25 patients with a penumbra >15 mL, 9 patients had an IVIM penumbra perfusion lesion (56 ± 76 mL), and 16 did not. Patients with an IVIM penumbra perfusion lesion had a larger infarct core (82 ± 84 mL) at baseline, a larger infarct growth (68 ± 40 mL), and a larger final infarct size (126 ± 81 mL) on follow-up images compared to the patients without (resp. 20 ± 17 mL, p < 0.05; 13 ± 19 mL, p < 0.01; 29 ± 24 mL, p < 0.05). All IVIM penumbra perfusion lesions progressed to infarction despite thrombectomy treatment.

CONCLUSIONS:

IVIM is a promising tool to assess the quality of the collateral blood flow in hyperacute stroke. IVIM penumbra perfusion lesion may be a marker of nonsalvageable tissue despite treatment with thrombectomy, suggesting that the IVIM penumbra perfusion lesion might be counted to the stroke core, together with the DWI lesion.

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