Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

Sven P.R. Luijten; Daniel Bos; Pieter Jan van Doormaal; Mayank Goyal; Rick M. Dijkhuizen; Diederik W.J. Dippel; Bob Roozenbeek; Aad van der Lugt; Esther A.H. Warnert

doi:10.1016/j.nicl.2023.103340

Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

Sven P.R. Luijten^*, Daniel Bos, Pieter Jan van Doormaal, Mayank Goyal, Rick M. Dijkhuizen, Diederik W.J. Dippel, Bob Roozenbeek, Aad van der Lugt, Esther A.H. Warnert

^*Corresponding author for this work

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Abstract

Restoring blood flow to brain tissue at risk of infarction is essential for tissue survival and clinical outcome. We used cerebral blood flow (CBF) quantified with multiple post-labeling delay (PLD) pseudocontinuous arterial spin labeling (ASL) MRI after ischemic stroke and assessed the association between CBF and early neurological outcome. We acquired ASL with 7 PLDs at 3.0 T in large vessel occlusion stroke patients at 24 h. We quantified CBF relative to the contralateral hemisphere (rCBF) and defined hyperperfusion as a ≥30% increase and hypoperfusion as a ≥40% decrease in rCBF. We included 44 patients (median age: 70 years, median NIHSS: 13, 40 treated with endovascular thrombectomy) of whom 37 were recanalized. Hyperperfusion in ischemic core occurred in recanalized but not in non-recanalized patients (65.8% vs 0%, p = 0.006). Hypoperfusion occurred only in the latter group (0% vs 85.7%, p < 0.001). In recanalized patients, hyperperfusion was also seen in salvaged penumbra (38.9%). Higher rCBF in ischemic core (aβ, −2.75 [95% CI: −4.11 to −1.40]) and salvaged penumbra (aβ, −5.62 [95% CI: −9.57 to −1.68]) was associated with lower NIHSS scores at 24 h. In conclusion, hyperperfusion frequently occurs in infarcted and salvaged brain tissue following successful recanalization and early neurological outcome is positively associated with the level of reperfusion.

Original language	English
Article number	103340
Journal	NeuroImage: Clinical
Volume	37
DOIs	https://doi.org/10.1016/j.nicl.2023.103340
Publication status	E-pub ahead of print - 31 Jan 2023

Bibliographical note

Funding Information:
This work is funded in part through the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences & Health to stimulate public–private partnerships (LSHM17016). This work was further funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus. EW is funded by a “Veni Vernieuwingsimpuls” from the Dutch Research Council entitled “Food for thought: Oxygen delivery to the brain”, Grant No 91619121.

Publisher Copyright: © 2023 Erasmus MC University Medical Center

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Luijten, S. P. R., Bos, D., van Doormaal, P. J., Goyal, M., Dijkhuizen, R. M., Dippel, D. W. J., Roozenbeek, B., van der Lugt, A., & Warnert, E. A. H. (2023). Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome. NeuroImage: Clinical, 37, [103340]. https://doi.org/10.1016/j.nicl.2023.103340

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title = "Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome",

abstract = "Restoring blood flow to brain tissue at risk of infarction is essential for tissue survival and clinical outcome. We used cerebral blood flow (CBF) quantified with multiple post-labeling delay (PLD) pseudocontinuous arterial spin labeling (ASL) MRI after ischemic stroke and assessed the association between CBF and early neurological outcome. We acquired ASL with 7 PLDs at 3.0 T in large vessel occlusion stroke patients at 24 h. We quantified CBF relative to the contralateral hemisphere (rCBF) and defined hyperperfusion as a ≥30% increase and hypoperfusion as a ≥40% decrease in rCBF. We included 44 patients (median age: 70 years, median NIHSS: 13, 40 treated with endovascular thrombectomy) of whom 37 were recanalized. Hyperperfusion in ischemic core occurred in recanalized but not in non-recanalized patients (65.8% vs 0%, p = 0.006). Hypoperfusion occurred only in the latter group (0% vs 85.7%, p < 0.001). In recanalized patients, hyperperfusion was also seen in salvaged penumbra (38.9%). Higher rCBF in ischemic core (aβ, −2.75 [95% CI: −4.11 to −1.40]) and salvaged penumbra (aβ, −5.62 [95% CI: −9.57 to −1.68]) was associated with lower NIHSS scores at 24 h. In conclusion, hyperperfusion frequently occurs in infarcted and salvaged brain tissue following successful recanalization and early neurological outcome is positively associated with the level of reperfusion.",

author = "Luijten, {Sven P.R.} and Daniel Bos and {van Doormaal}, {Pieter Jan} and Mayank Goyal and Dijkhuizen, {Rick M.} and Dippel, {Diederik W.J.} and Bob Roozenbeek and {van der Lugt}, Aad and Warnert, {Esther A.H.}",

note = "Funding Information: This work is funded in part through the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences & Health to stimulate public–private partnerships (LSHM17016). This work was further funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus. EW is funded by a “Veni Vernieuwingsimpuls” from the Dutch Research Council entitled “Food for thought: Oxygen delivery to the brain”, Grant No 91619121. Publisher Copyright: {\textcopyright} 2023 Erasmus MC University Medical Center",

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doi = "10.1016/j.nicl.2023.103340",

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T1 - Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

AU - Luijten, Sven P.R.

AU - Bos, Daniel

AU - van Doormaal, Pieter Jan

AU - Goyal, Mayank

AU - Dijkhuizen, Rick M.

AU - Dippel, Diederik W.J.

AU - Roozenbeek, Bob

AU - van der Lugt, Aad

AU - Warnert, Esther A.H.

N1 - Funding Information: This work is funded in part through the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences & Health to stimulate public–private partnerships (LSHM17016). This work was further funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus. EW is funded by a “Veni Vernieuwingsimpuls” from the Dutch Research Council entitled “Food for thought: Oxygen delivery to the brain”, Grant No 91619121. Publisher Copyright: © 2023 Erasmus MC University Medical Center

PY - 2023/1/31

Y1 - 2023/1/31

N2 - Restoring blood flow to brain tissue at risk of infarction is essential for tissue survival and clinical outcome. We used cerebral blood flow (CBF) quantified with multiple post-labeling delay (PLD) pseudocontinuous arterial spin labeling (ASL) MRI after ischemic stroke and assessed the association between CBF and early neurological outcome. We acquired ASL with 7 PLDs at 3.0 T in large vessel occlusion stroke patients at 24 h. We quantified CBF relative to the contralateral hemisphere (rCBF) and defined hyperperfusion as a ≥30% increase and hypoperfusion as a ≥40% decrease in rCBF. We included 44 patients (median age: 70 years, median NIHSS: 13, 40 treated with endovascular thrombectomy) of whom 37 were recanalized. Hyperperfusion in ischemic core occurred in recanalized but not in non-recanalized patients (65.8% vs 0%, p = 0.006). Hypoperfusion occurred only in the latter group (0% vs 85.7%, p < 0.001). In recanalized patients, hyperperfusion was also seen in salvaged penumbra (38.9%). Higher rCBF in ischemic core (aβ, −2.75 [95% CI: −4.11 to −1.40]) and salvaged penumbra (aβ, −5.62 [95% CI: −9.57 to −1.68]) was associated with lower NIHSS scores at 24 h. In conclusion, hyperperfusion frequently occurs in infarcted and salvaged brain tissue following successful recanalization and early neurological outcome is positively associated with the level of reperfusion.

AB - Restoring blood flow to brain tissue at risk of infarction is essential for tissue survival and clinical outcome. We used cerebral blood flow (CBF) quantified with multiple post-labeling delay (PLD) pseudocontinuous arterial spin labeling (ASL) MRI after ischemic stroke and assessed the association between CBF and early neurological outcome. We acquired ASL with 7 PLDs at 3.0 T in large vessel occlusion stroke patients at 24 h. We quantified CBF relative to the contralateral hemisphere (rCBF) and defined hyperperfusion as a ≥30% increase and hypoperfusion as a ≥40% decrease in rCBF. We included 44 patients (median age: 70 years, median NIHSS: 13, 40 treated with endovascular thrombectomy) of whom 37 were recanalized. Hyperperfusion in ischemic core occurred in recanalized but not in non-recanalized patients (65.8% vs 0%, p = 0.006). Hypoperfusion occurred only in the latter group (0% vs 85.7%, p < 0.001). In recanalized patients, hyperperfusion was also seen in salvaged penumbra (38.9%). Higher rCBF in ischemic core (aβ, −2.75 [95% CI: −4.11 to −1.40]) and salvaged penumbra (aβ, −5.62 [95% CI: −9.57 to −1.68]) was associated with lower NIHSS scores at 24 h. In conclusion, hyperperfusion frequently occurs in infarcted and salvaged brain tissue following successful recanalization and early neurological outcome is positively associated with the level of reperfusion.

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Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

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