Computed tomography and magnetic resonance perfusion imaging in ischemic stroke

definitions and thresholds

Krishna A Dani, Ralph G. R. Thomas, Francesca M. Chappell, Kirsten Shuler, Mary J. MacLeod, Keith W. Muir, Joanna M. Wardlaw, Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Objective:
Cerebral perfusion imaging with computed tomography (CT) or magnetic resonance (MR) is widely available. The optimum perfusion values to identify tissue at risk of infarction in acute stroke are unclear. We systematically reviewed CT and MR perfusion imaging in acute ischemic stroke.

Methods:
We searched for papers on MR or CT perfusion performed <24 hours after stroke that assessed perfusion thresholds, mean perfusion lesion values, or lesion volumes. We extracted definitions and perfusion values. We compared definitions and evaluated perfusion thresholds for “nonviable”/”at risk” and “at risk”/”not at risk tissue” thresholds.

Results:
Among 7,152 papers, 69 met inclusion criteria for analysis of definitions (49 MR and 20 CT), 21 MR (n = 551), and 10 CT (n = 266) papers, median sample size 22, provided thresholds. We found multiple definitions for tissue states, eg, tissue at risk, 18; nonviable tissue, 12; 16, no definition. Perfusion parameters varied widely; eg, 9 different MR, 6 different CT parameters for the “at risk”/”not at risk threshold.” Median threshold values varied up to 4-fold, eg, for the “at risk”/”not at risk threshold,” median cerebral blood flow ranged from 18 to 37ml/100g/min; mean transit time from 1.8 to 8.3 seconds relative to the contralateral side. The influence of reperfusion and duration of ischemia could not be assessed.

Interpretation:
CT and MR perfusion imaging viability thresholds in stroke are derived from small numbers of patients, variable perfusion analysis methods and definitions of tissue states. Greater consistency of methods would help determine reliable perfusion viability values for wider clinical use of perfusion imaging. ANN NEUROL 2011
Original languageEnglish
Pages (from-to)384-401
Number of pages18
JournalAnnals of Neurology
Volume70
Issue number3
Early online date27 Jul 2011
DOIs
Publication statusPublished - Sep 2011

Fingerprint

Magnetic Resonance Angiography
Perfusion
Stroke
Tomography
Magnetic Resonance Spectroscopy
Perfusion Imaging
Cerebrovascular Circulation
Sample Size
Infarction
Reperfusion
Ischemia

Keywords

  • brain
  • brain ischemia
  • cerebral infarction
  • cerebrovascular circulation
  • data interpretation, statistical
  • data mining
  • humans
  • magnetic resonance imaging
  • perfusion
  • research design
  • risk assessment
  • stroke
  • tomography, X-ray computed

Cite this

Dani, K. A., Thomas, R. G. R., Chappell, F. M., Shuler, K., MacLeod, M. J., Muir, K. W., ... Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study (2011). Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Annals of Neurology, 70(3), 384-401. https://doi.org/10.1002/ana.22500

Computed tomography and magnetic resonance perfusion imaging in ischemic stroke : definitions and thresholds. / Dani, Krishna A; Thomas, Ralph G. R.; Chappell, Francesca M.; Shuler, Kirsten; MacLeod, Mary J.; Muir, Keith W.; Wardlaw, Joanna M.; Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study.

In: Annals of Neurology, Vol. 70, No. 3, 09.2011, p. 384-401.

Research output: Contribution to journalArticle

Dani, KA, Thomas, RGR, Chappell, FM, Shuler, K, MacLeod, MJ, Muir, KW, Wardlaw, JM & Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study 2011, 'Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds', Annals of Neurology, vol. 70, no. 3, pp. 384-401. https://doi.org/10.1002/ana.22500
Dani, Krishna A ; Thomas, Ralph G. R. ; Chappell, Francesca M. ; Shuler, Kirsten ; MacLeod, Mary J. ; Muir, Keith W. ; Wardlaw, Joanna M. ; Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study. / Computed tomography and magnetic resonance perfusion imaging in ischemic stroke : definitions and thresholds. In: Annals of Neurology. 2011 ; Vol. 70, No. 3. pp. 384-401.
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abstract = "Objective:Cerebral perfusion imaging with computed tomography (CT) or magnetic resonance (MR) is widely available. The optimum perfusion values to identify tissue at risk of infarction in acute stroke are unclear. We systematically reviewed CT and MR perfusion imaging in acute ischemic stroke.Methods:We searched for papers on MR or CT perfusion performed <24 hours after stroke that assessed perfusion thresholds, mean perfusion lesion values, or lesion volumes. We extracted definitions and perfusion values. We compared definitions and evaluated perfusion thresholds for “nonviable”/”at risk” and “at risk”/”not at risk tissue” thresholds.Results:Among 7,152 papers, 69 met inclusion criteria for analysis of definitions (49 MR and 20 CT), 21 MR (n = 551), and 10 CT (n = 266) papers, median sample size 22, provided thresholds. We found multiple definitions for tissue states, eg, tissue at risk, 18; nonviable tissue, 12; 16, no definition. Perfusion parameters varied widely; eg, 9 different MR, 6 different CT parameters for the “at risk”/”not at risk threshold.” Median threshold values varied up to 4-fold, eg, for the “at risk”/”not at risk threshold,” median cerebral blood flow ranged from 18 to 37ml/100g/min; mean transit time from 1.8 to 8.3 seconds relative to the contralateral side. The influence of reperfusion and duration of ischemia could not be assessed.Interpretation:CT and MR perfusion imaging viability thresholds in stroke are derived from small numbers of patients, variable perfusion analysis methods and definitions of tissue states. Greater consistency of methods would help determine reliable perfusion viability values for wider clinical use of perfusion imaging. ANN NEUROL 2011",
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T1 - Computed tomography and magnetic resonance perfusion imaging in ischemic stroke

T2 - definitions and thresholds

AU - Dani, Krishna A

AU - Thomas, Ralph G. R.

AU - Chappell, Francesca M.

AU - Shuler, Kirsten

AU - MacLeod, Mary J.

AU - Muir, Keith W.

AU - Wardlaw, Joanna M.

AU - Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study

N1 - Copyright © 2011 American Neurological Association.

PY - 2011/9

Y1 - 2011/9

N2 - Objective:Cerebral perfusion imaging with computed tomography (CT) or magnetic resonance (MR) is widely available. The optimum perfusion values to identify tissue at risk of infarction in acute stroke are unclear. We systematically reviewed CT and MR perfusion imaging in acute ischemic stroke.Methods:We searched for papers on MR or CT perfusion performed <24 hours after stroke that assessed perfusion thresholds, mean perfusion lesion values, or lesion volumes. We extracted definitions and perfusion values. We compared definitions and evaluated perfusion thresholds for “nonviable”/”at risk” and “at risk”/”not at risk tissue” thresholds.Results:Among 7,152 papers, 69 met inclusion criteria for analysis of definitions (49 MR and 20 CT), 21 MR (n = 551), and 10 CT (n = 266) papers, median sample size 22, provided thresholds. We found multiple definitions for tissue states, eg, tissue at risk, 18; nonviable tissue, 12; 16, no definition. Perfusion parameters varied widely; eg, 9 different MR, 6 different CT parameters for the “at risk”/”not at risk threshold.” Median threshold values varied up to 4-fold, eg, for the “at risk”/”not at risk threshold,” median cerebral blood flow ranged from 18 to 37ml/100g/min; mean transit time from 1.8 to 8.3 seconds relative to the contralateral side. The influence of reperfusion and duration of ischemia could not be assessed.Interpretation:CT and MR perfusion imaging viability thresholds in stroke are derived from small numbers of patients, variable perfusion analysis methods and definitions of tissue states. Greater consistency of methods would help determine reliable perfusion viability values for wider clinical use of perfusion imaging. ANN NEUROL 2011

AB - Objective:Cerebral perfusion imaging with computed tomography (CT) or magnetic resonance (MR) is widely available. The optimum perfusion values to identify tissue at risk of infarction in acute stroke are unclear. We systematically reviewed CT and MR perfusion imaging in acute ischemic stroke.Methods:We searched for papers on MR or CT perfusion performed <24 hours after stroke that assessed perfusion thresholds, mean perfusion lesion values, or lesion volumes. We extracted definitions and perfusion values. We compared definitions and evaluated perfusion thresholds for “nonviable”/”at risk” and “at risk”/”not at risk tissue” thresholds.Results:Among 7,152 papers, 69 met inclusion criteria for analysis of definitions (49 MR and 20 CT), 21 MR (n = 551), and 10 CT (n = 266) papers, median sample size 22, provided thresholds. We found multiple definitions for tissue states, eg, tissue at risk, 18; nonviable tissue, 12; 16, no definition. Perfusion parameters varied widely; eg, 9 different MR, 6 different CT parameters for the “at risk”/”not at risk threshold.” Median threshold values varied up to 4-fold, eg, for the “at risk”/”not at risk threshold,” median cerebral blood flow ranged from 18 to 37ml/100g/min; mean transit time from 1.8 to 8.3 seconds relative to the contralateral side. The influence of reperfusion and duration of ischemia could not be assessed.Interpretation:CT and MR perfusion imaging viability thresholds in stroke are derived from small numbers of patients, variable perfusion analysis methods and definitions of tissue states. Greater consistency of methods would help determine reliable perfusion viability values for wider clinical use of perfusion imaging. ANN NEUROL 2011

KW - brain

KW - brain ischemia

KW - cerebral infarction

KW - cerebrovascular circulation

KW - data interpretation, statistical

KW - data mining

KW - humans

KW - magnetic resonance imaging

KW - perfusion

KW - research design

KW - risk assessment

KW - stroke

KW - tomography, X-ray computed

U2 - 10.1002/ana.22500

DO - 10.1002/ana.22500

M3 - Article

VL - 70

SP - 384

EP - 401

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 3

ER -