Pial collaterals limit stroke progression and metabolic stress in hypoperfused tissue: An MRI perfusion and mq‐BOLD study

Author:

Frank Franziska1,Kaczmarz Stephan2,Preibisch Christine23,Deichmann Ralf4,Nöth Ulrike4,Wagner Marlies45,Seiler Alexander146ORCID

Affiliation:

1. Department of Neurology University Hospital Frankfurt (Goethe University) Frankfurt Germany

2. Department of Diagnostic and Interventional Neuroradiology School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) Munich Germany

3. Clinic of Neurology School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) Munich Germany

4. Brain Imaging Center Goethe University Frankfurt Frankfurt Germany

5. Institute of Neuroradiology University Hospital Frankfurt (Goethe University) Frankfurt Germany

6. Department of Neurology and Neurovascular Center University Hospital Schleswig‐Holstein, Campus Kiel Kiel Germany

Abstract

AbstractBackground and PurposeIn acute ischemic stroke (AIS) due to large‐vessel occlusion (LVO), the relationship between cerebral oxygen extraction fraction (OEF) as the hallmark of the ischemic penumbra and leptomeningeal collateral supply is not well established. We aimed to investigate the relationship between pial collateralization and tissue oxygen extraction in patients with LVO using magnetic resonance imaging (MRI).MethodsData from 14 patients with anterior circulation LVO who underwent MRI before acute stroke treatment were analyzed. In addition to diffusion‐weighted imaging and perfusion‐weighted imaging (PWI), the protocol comprised sequences for multiparametric quantitative blood‐oxygen‐level‐dependent imaging for the calculation of relative OEF (rOEF). Pial collateral supply was quantitatively assessed by analyzing the signal variance in T2*‐weighted PWI time series. Relationships between collateral supply, infarct volume, rOEF in peri‐infarct hypoperfused tissue, and clinical stroke severity were assessed.ResultsThe PWI‐based parameter quantifying collateral supply was negatively correlated with baseline ischemic core volume and rOEF in the hypoperfused peri‐infarct area (p < .01). Both reduced collateral supply and increased rOEF correlated significantly with higher scores on the National Institutes of Health Stroke Scale (p < .05). Increased rOEF within hypoperfused tissue was associated with higher baseline (p = .043) and follow‐up infarct volume (p = .009).ConclusionsSignal variance‐based mapping of collaterals with PWI depicts pial collateral supply, which is closely tied to tissue pathophysiology and clinical and imaging outcomes. Magnetic‐resonance‐derived mapping of cerebral rOEF reveals penumbral characteristics of hypoperfused tissue and might provide a promising imaging biomarker in AIS.

Publisher

Wiley

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