Assessment of ischemic penumbra in patients with hyperacute stroke using amide proton transfer (APT) chemical exchange saturation transfer (CEST) MRI.
Assessment of ischemic penumbra in patients with hyperacute stroke using amide proton transfer (APT) chemical exchange saturation transfer (CEST) MRI.
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DOI：
10.1002/nbm.3048
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发表时间：
2014-02
影响因子：
2.9
通讯作者：
Donahue, Manus J.
中科院分区：
文献类型：
--
作者：
Tietze, Anna;Blicher, Jakob;Mikkelsen, Irene Klaerke;Ostergaard, Leif;Strother, Megan K.;Smith, Seth A.;Donahue, Manus J.
关键词：
化学交换饱和转移（CEST）衍生的pH加权酰胺质子转移（APT）MRI在动物研究中有望在这里预测缺血性组织的梗塞风险。 - 据报道，据报道健康志愿者（n = 5）和急性发作的患者（n = 10），呼吸造影剂，灌注，扩散，残疾和最终梗死体积（击球后23-92天）之间的评估和最终的梗塞体积（势力23-92天）和急性发作的患者之间的评估（n = 10）症状（0-4H：n = 7;不确定的发作<24H：n = 3）用扩散和灌注加权MRI扫描，流体减弱了反转恢复（FLAIR）和CEST。 APT指数是在基础设施核心，处于危险的组织中（峰值，TTP，延长）和最终基础架构的平均值（平均值±S.D。）。 ±0.005;洛伦兹：0.045±0.006）与正常同样的白色 - 摩尔（NAWM）患者（不对称：0.022±0.003; Lorentzian; Lorentzian：0.048±0.003），0.048±0.003），0.048±0.003）的APT值没有显着差异（p> 0.05）。然而，与NAWM相比，患者的缺血区域（p = 0.03）的效果降低了。与组织酸中毒相比，最终的梗塞区域中的恰当信号与酸中毒一致。在临床上可用的现场强度（例如3.0T）上的开发是充分了解适当成像对指导患者过度急性治疗的潜力的必要条件。
Chemical exchange saturation transfer (CEST)-derived pH-weighted Amide Proton Transfer (APT) MRI has shown promise in animal studies for predicting infarction risk in ischemic tissue. Here, APT MRI was translated to acute human stroke patients (1–24 hrs post-symptom-onset) and assessments between APT contrast, perfusion, diffusion, disability, and final infarct volume (23–92 days post-stroke) are reported. Healthy volunteers (n=5) and patients (n=10) with acute onset of symptoms (0–4h: n=7; uncertain onset <24h: n=3) were scanned with diffusion- and perfusion-weighted MRI, FLuid Attenuated Inversion Recovery (FLAIR) and CEST. Traditional asymmetry as well as a Lorentzian-based APT index were calculated in the infarct core, at-risk tissue (time-to-peak, TTP, lengthening), and the final infarct volume. On average (mean±s.d.), control white matter APT values (asymmetry: 0.019±0.005; Lorentzian: 0.045±0.006) were not significantly different (P>0.05) than APT values in normal-appearing-white-matter (NAWM) of patients (asymmetry: 0.022±0.003; Lorentzian: 0.048±0.003), however ischemic regions in patients had reduced (P=0.03) APT effects compared to NAWM. Representative cases are presented whereby the APT contrast is compared quantitatively to contrast from other imaging modalities. Findings vary between patients; in some patients a trend for a reduction of the APT signal in the final infarct region compared to at-risk tissue was observed, consistent with tissue acidosis. However, in other patients no relationship was observed in the infarct core and final infarct volume. Larger clinical studies in combination with focused efforts on sequence development at clinically available field strengths (e.g., 3.0T) are necessary to fully understand the potential of APT imaging for guiding hyperacute management of patients.
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