Refined Ischemic Penumbra Imaging with Tissue pH and Diffusion Kurtosis Magnetic Resonance Imaging.
Acidification
Acute stroke
Diffusion kurtosis imaging (DKI)
MRI mismatch
Penumbra
pH MRI
Journal
Translational stroke research
ISSN: 1868-601X
Titre abrégé: Transl Stroke Res
Pays: United States
ID NLM: 101517297
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
12
02
2020
accepted:
18
10
2020
revised:
14
10
2020
pubmed:
8
11
2020
medline:
14
1
2022
entrez:
7
11
2020
Statut:
ppublish
Résumé
Imaging has played a vital role in our mechanistic understanding of acute ischemia and the management of acute stroke patients. The most recent DAWN and DEFUSE-3 trials showed that endovascular therapy could be extended to a selected group of late-presenting stroke patients with the aid of imaging. Although perfusion and diffusion MRI have been commonly used in stroke imaging, the approximation of their mismatch as the penumbra is oversimplified, particularly in the era of endovascular therapy. Briefly, the hypoperfusion lesion includes the benign oligemia that does not proceed to infarction. Also, with prompt and effective reperfusion therapy, a portion of the diffusion lesion is potentially reversible. Therefore, advanced imaging that provides improved ischemic tissue characterization may enable new experimental stroke therapeutics and eventually further individualize stroke treatment upon translation to the clinical setting. Specifically, pH imaging captures tissue of altered metabolic state that demarcates the hypoperfused lesion into ischemic penumbra and benign oligemia, which remains promising to define the ischemic penumbra's outer boundary. On the other hand, diffusion kurtosis imaging (DKI) differentiates the most severely damaged and irreversibly injured diffusion lesion from the portion of diffusion lesion that is potentially reversible, refining the inner boundary of the penumbra. Altogether, the development of advanced imaging has the potential to not only transform the experimental stroke research but also aid clinical translation and patient management.
Identifiants
pubmed: 33159656
doi: 10.1007/s12975-020-00868-z
pii: 10.1007/s12975-020-00868-z
pmc: PMC8102648
mid: NIHMS1644948
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
742-753Subventions
Organisme : NIH HHS
ID : P51 OD011132
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS083654
Pays : United States
Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
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