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The Value of MR Perfusion in Acute Ischemic Stroke

,

Document Type : Review Article

Abstract

BACKGROUND:
Stroke is a clinical diagnosis that refers to sudden onset focal neurological deficit of presumed vascular origin. MR perfusion (MRP) provide a rapid, quantitative, and easily interpretable visual assessment                   of the penumbra.
OBJECTIVE:
To study the value of MR perfusion in acute ischemic stroke within 1st 24hr.
PATIENTS AND METHODS:
Diffusion weighted images (DWI) and perfusion weighted images(PWI) were obtained in 30 ischemic stroke patients within 24 hours after symptoms onset. Perfusion diffusion mismatch (PDM) was analyzed by automated software that aligned apparent diffusion coefficient (ADC) defect with mean transient time (MTT) or time to maximum (Tmax) map.
RESULTS:
Type I (PWI>DWI) in (7) patients (23%), type II (PWI=DWI) is the main pattern described in (20) patients (67%). Average rCBF ratio was significantly reduced in the ischemic core (0.28±0.14)                      as compared to the normal brain tissue (0.51±0.14). Average rCBV ratio was significantly decreased in the ischemic core (0.35±0.15) as compared with the normal brain (0.90±0.88). MTT value was significantly higher in the infarct core (7.6 sec±0.92) than in the normal brain tissue (4.3sec±0.32).
There was significant reduction in average rCBF ratio in the penumbra (0.54±0.14) in comparison with normal brain tissue (0.66±0.14). A non-significant reduction in average rCBV ratio within penumbra (0.84± 0.29) in relation to normal brain tissue (0.98±0.25).  MTT value in the penumbra was significantly higher (4.6sec±0.45) than in the normal brain tissue (4.07sec±0.18).
CONCLUSION:
Type II PDM pattern was the dominant pattern in patient with acute ischemic stroke in the 1st 24 hours. Salvageable penumbra in type I PDM described in (78%) of patients. rCBF in penumbra was higher than ischemic core and lower than normal brain and was the most useful parameter in defining ischemic penumbra and for follow up of patients with acute ischemic stroke.
 

Keywords

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Iraqi Postgraduate Medical Journal
Volume 22, Issue 4
October 2023
Page 440-447
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