Discrimination between progressive penumbra and benign oligemia of the diffusion-perfusion mismatch region by amide proton transfer-weighted imaging

Yalin Wu; Han Li; Chenyang Pei; Phillip Zhe Sun; Jianzhong Yin

doi:10.1016/j.mri.2023.02.006

Discrimination between progressive penumbra and benign oligemia of the diffusion-perfusion mismatch region by amide proton transfer-weighted imaging

Magn Reson Imaging. 2023 Jun:99:123-129. doi: 10.1016/j.mri.2023.02.006. Epub 2023 Feb 21.

Authors

Yalin Wu¹, Han Li², Chenyang Pei², Phillip Zhe Sun³, Jianzhong Yin⁴

Affiliations

¹ Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
² Tianjin Medical University, Tianjin, China.
³ Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: pzhesun@emory.edu.
⁴ Department of Radiology, Haikou People's Hospital, Affiliated Haikou Hospital of Xiangya Medical school, Central South University, Haikou, Hainan Province, China. Electronic address: jianzhong.yin@gmail.com.

PMID: 36822450
DOI: 10.1016/j.mri.2023.02.006

Abstract

Purpose: Amide proton transfer-weighted (APTw) imaging was an effective tool to reveal the tissue acidosis of acute ischemic stroke. This study aimed to evaluate the ability of APTw MRI to distinguish progressive penumbra and benign oligemia in the diffusion-perfusion mismatch region.

Materials and methods: 38 acute cerebral infarction patients who underwent a comprehensive MRI examination, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), APT imaging, and a follow-up scan in one week were recruited. There were 12 DWI/PWI match cases. The DWI/PWI mismatch patients were divided into 10 progressive cases and 16 stable cases according to the lesion size on the follow-up DWI image compared to the admission scan. Three ROIs: infarction lesion, peripheral, and contralateral normal regions were measured on each subject's MTRasym map. The Friedman test was used to compare the changes of MTRasym among three different regions within each group. The Kruskal-Wallis ANOVA test was used to compare them among the same region of different groups. The correlation between the MTRasym of the peripheral region and the lesion enlargement was analyzed by the Spearman test.

Results: The MTRasym at the infarction lesion of all three groups showed significant decrease to the contralateral normal tissue. In the progressive mismatch group, the MTRasym at the peripheral region within the DWI/PWI mismatch showed a significant difference with the contralateral normal region and no difference with the infarct core. Whereas both the MTRasym at the peripheral region of the stable mismatch and match groups had no significant difference with the contralateral side, but the differences were significant from those of the central core. When comparing the peripheral region of three groups, the MTRasym of the progressive mismatch group showed a significant decrease to that of the stable mismatch and match groups. The MTRasym of the peripheral region showed a negative correlation with lesion enlargement.

Conclusion: APTw imaging is promising to stratify the heterogeneous PWI/DWI mismatch region and benefit the clinical treatment.

Keywords: Acute infarction; Amide proton transfer (APT); Benign oligemia; Diffusion; Penumbra; Perfusion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amides
Diffusion Magnetic Resonance Imaging / methods
Humans
Infarction
Ischemic Stroke*
Magnetic Resonance Imaging / methods
Perfusion
Protons
Stroke* / pathology

Substances

Protons
Amides