Improving the prediction of final infarct size in acute stroke with bolus delay-corrected perfusion MRI measures

J Magn Reson Imaging. 2004 Dec;20(6):941-7. doi: 10.1002/jmri.20216.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Blood Flow Velocity
  • Blood Volume
  • Cerebrovascular Circulation
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / pathology
  • Infarction, Middle Cerebral Artery / physiopathology
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Predictive Value of Tests