The Diffusion-Weighted Lesion in Acute Stroke: Heterogeneous Patterns of Flow/Metabolism Uncoupling as Assessed by Quantitative Positron Emission Tomography

Vol. 19, No. 4, 2005

Free Abstract Article (Fulltext) Article (PDF 2056 KB)

Original Paper

The Diffusion-Weighted Lesion in Acute Stroke: Heterogeneous Patterns of Flow/Metabolism Uncoupling as Assessed by Quantitative Positron Emission Tomography¹
Joseph V. Guadagno^a, Elizabeth A. Warburton^{a, b}, Peter S. Jones^a, Tim D. Fryer^c, Diana J. Day^a, Jonathan H. Gillard^{c, e}, T. Adrian Carpenter^c, Franklin I. Aigbirhio^{a, c}, Christopher J. Price^{a, d}, Jean-Claude Baron^{a, c}

^aDepartment of Clinical Neurosciences, University of Cambridge,
^bStroke Unit, Addenbrooke's Hospital,
^cWolfson Brain Imaging Center, and Departments of
^dMedicine and
^eRadiology, University of Cambridge Clinical School, Cambridge, UK

Address of Corresponding Author

Cerebrovasc Dis 2005;19:239-246 (DOI: 10.1159/000084087)

Key Words

Stroke
Positron emission tomography
Diffusion-weighted imaging
Cerebral blood flow

Abstract

Background: To investigate what the hyperintense lesion in diffusion-weighted imaging (DWI) of acute ischaemic stroke represents metabolically, we prospectively imaged acute carotid-territory stroke patients with DWI along with fully quantitative positron emission tomography (PET), which gives physiological maps of cerebral blood flow (CBF), the cerebral metabolic rate of oxygen (CMRO₂) and the oxygen extraction fraction (OEF). Method: Of 10 patients who consented, 5 (3 males, 2 females, 53-84 years, NIHSS 6-16) completed the imaging protocol of back-to-back DWI and PET within 21 (mean 15.7, range 7-21) h of stroke onset. All images were co-registered with the DWI lesion forming a region of interest (ROI) that was transferred to the PET parametric maps (OEF, CBF, CMRO₂). Patterns of blood flow and metabolism were assessed within the DWI ROI. Results: Within the DWI lesions, the following patterns were observed: very low CBF and CMRO₂/variable OEF; low CBF/high OEF, and high CBF/low OEF. There was a heterogeneity of patterns between and within DWI lesions. In addition, areas of hyperperfusion (with low OEF) and areas of hypoperfusion (with high OEF) were seen outside the DWI lesions. Conclusion: The DWI lesion does not have a single flow/metabolism counterpart, suggesting that it reflects various stages of the ischaemic process.

Author Contacts

Prof. J.-C. Baron
Box 83, R3 Neurosciences, Cambridge University Department of Neurology
Addenbrooke's Hospital, Hills Road
Cambridge, CB2 2QQ (UK)
Tel. +44 1223 217 806, Fax +44 1223 217 909, E-Mail jcb54@cam.ac.uk

Article Information

Received: October 20, 2004
Accepted: November 2, 2004
Published online: February 22, 2005
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 2, Number of References : 28

Medline Abstract (ID 15741718)

Download Citation

Cited In

This journal is part of the first subject package of the Karger

Journal Archive Collection

Information on packages (PDF)
Free sample issues

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.