The value of resting-state functional MRI in subacute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced perfusion MRI

Ling Ni,Yun Xu,Jingwei Li,Weiping Li,Xin Zhang,Ming Li,Fangfang Wang,Renyuan Liu,Bin Zhu,Arno Villringer,Yufeng Zang,Bing Zhang,Fei Zhou,Yating Lv,Hui Zhao,Haiping Yu,Christopher G Schwarz,Wenbo Wu

doi:10.1038/srep41586

Abstract

To evaluate the potential clinical value of the time-shift analysis (TSA) approach for resting-state fMRI (rs-fMRI) blood oxygenation level-dependent (BOLD) data in detecting hypoperfusion of subacute stroke patients through comparison with dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI). Forty patients with subacute stroke (3–14 days after neurological symptom onset) underwent MRI examination. Cohort A: 31 patients had MRA, DSC-PWI and BOLD data. Cohort B: 9 patients had BOLD and MRA data. The time delay between the BOLD time course in each voxel and the mean signal of global and contralateral hemisphere was calculated using TSA. Time to peak (TTP) was employed to detect hypoperfusion. Among cohort A, 14 patients who had intracranial large-vessel occlusion/stenosis with sparse collaterals showed hypoperfusion by both of the two approaches, one with abundant collaterals showed neither TTP nor TSA time delay. The remaining 16 patients without obvious MRA lesions showed neither TTP nor TSA time delay. Among cohort B, eight patients showed time delay areas. The TSA approach was a promising alternative to DSC-PWI for detecting hypoperfusion in subacute stroke patients who had obvious MRA lesions with sparse collaterals, those with abundant collaterals would keep intact local perfusion.

Highlights

Hypoperfusion volume was considered as a marker of response to treatment aimed to improve cerebral perfusion in the subacute phase of ischemic stroke
For those 31 patients with combined Dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) and Blood oxygenation level-dependent imaging (BOLD) data, 15 patients had intracranial large-vessel occlusion or stenosis confirmed by MRA
The perfusion lesion sizes from TSA were larger than those obtained by DSC-PWI, the group average spatial overlap, i.e., Dice coefficient (DC), of the two measurements was DC(H) 0.58 ± 0.13 and DC(G) 0.59 ± 0.12, respectively (Table 1)

Summary

Introduction

Hypoperfusion volume was considered as a marker of response to treatment aimed to improve cerebral perfusion in the subacute phase of ischemic stroke. One study[9] found an association between improved perfusion of peri-infarct regions and restored function after blood pressure elevation therapy in patients with perfusion/diffusion mismatch up to seven days or more after the onset of symptoms[10]. They suggested that reperfusion may be effective in the subacute phase of ischemic stroke if there is still a substantial area of salvageable tissue identified by diffusion/perfusion mismatch. Resting-state functional magnetic resonance imaging (rs-fMRI) using Blood oxygenation level-dependent imaging (BOLD) is a noninvasive imaging technique which does not require contrast agent application and maintains high temporal resolution. We applied TSA combined with the DSC-PWI and MRA methods on subacute stroke patients, part of which having both BOLD scanning and DSC-PWI and the other part having only BOLD data, to further validate that rs-fMRI BOLD was able to detect perfusion injury in subacute stroke patients, had important implications for monitoring the perfusion status and establishing therapeutic regimen

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