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Neuroradiology |
1 From the MR Research Center, Presbyterian University Hospital, B855, 200 Lothrop St, Pittsburgh, PA 15213-2582. Received August 5, 1998; revision requested October 15; revision received December 15; accepted March 29, 1999. Supported in part by Public Health Service grants PO1 NS35949-01A1 and RO1 CA63661 and GE Medical Systems. Address reprint requests to K.R.T. (e-mail: keith@mrctr.upmc.edu).
PURPOSE: To investigate sodium magnetic resonance (MR) imaging for monitoring tissue viability in stroke.
MATERIALS AND METHODS: A comprehensive MR imaging protocol used to measure apparent diffusion coefficient and perfusion parameters was extended to include sodium imaging. Tissue sodium concentration was estimated by using a two-compartment model. This protocol lasted less than 45 minutes. These parameters were followed over the first 6 hours in a nonhuman primate model (n = 2) of acute embolic stroke without or with thrombolytic therapy. This protocol was used in patients in whom acute (<24 hours, n = 11) or nonacute (
24 hours, n = 31) stroke was ultimately confirmed.
RESULTS: The animal model showed abnormal diffusion and perfusion parameters in the lesion immediately after embolization, and these remained abnormal for over 6 hours. Tissue sodium concentration increased with time (5.7 mmol/L/h) unless halted with thrombolytic therapy. Regions with sodium concentrations over 70 mmol/L were histochemically verified as being infarcted. In patients in whom stroke older than 6 hours was clinically confirmed, sodium concentrations over 70 mmol/L were found in the appropriate brain regions.
CONCLUSION: Tissue sodium concentration provides a sensitive measure of tissue viability that is complementary to the diagnostic role of diffusion and perfusion imaging for ischemic insult.
Index terms: Brain, infarction, 10.771, 10.781 • Brain, MR, 10.121411, 10.121412 • Magnetic resonance (MR), diffusion study, 10.12144 • Magnetic resonance (MR), perfusion study, 10.12144 • Magnetic resonance (MR), sodium studies, 10.12147 • Thrombolysis, 10.1265, 10.771, 17.1265
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