HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2292020639v1 229/2/366    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liu, Y.-J. Articles by Liou, M. Search for Related Content PubMed PubMed Citation Articles by Liu, Y.-J. Articles by Liou, M.

Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory: Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging¹

¹ From the Department of Electrical Engineering, National Taiwan University, Taipei, R.O.C. (Y.J.L., H.W.C., I.J.H.); Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Number 325, Section 2, Cheng-Kung Rd, Neihu 114, Taipei, Taiwan, R.O.C. (Y.J.L., C.Y.C., H.W.C., C.S.L., S.C.C.); and Institute of Statistics Science, Academia Sinica, Taipei, Taiwan, R.O.C. (M.L.). Received May 31, 2002; revision requested July 29; final revision received April 11, 2003; accepted May 14. Supported in part by National Science Council grants NSC-89–2320-B-016–056-M08 and NSC-90–2213-E-002–003. Address correspondence to C.Y.C. (e-mail: sandy0928@seed.net.tw).

PURPOSE: To determine the temporal patterns of neuronal injury between infarction subtypes and their possible association with changes in cerebral blood volume (CBV).

MATERIALS AND METHODS: Twenty-five patients with ischemic injuries of middle cerebral arterial territories and receiving only conservative treatments were classified into territorial infarction (TI) (n = 16) and watershed infarction (WI) (n = 9) groups and were prospectively evaluated with longitudinal magnetic resonance (MR) examinations. Each patient underwent as many as five MR studies at various stroke stages following stroke symptom onset. Dynamic susceptibility-weighted contrast material–enhanced MR imaging was performed to yield the relative CBV (rCBV). Chemical shift imaging was used to measure the relative levels of N-acetylaspartate (NAA) and lactate of the ischemic brain tissue. Repeated-measures analysis of variance was used to examine the statistical significance in evolutional differences between TI and WI.

RESULTS: For patients with TI, rCBV followed a progressively increasing pattern, from initial low values (0.46 ± 0.28 [SD]) to peak high values (1.23 ± 0.34) at early chronic stage. Relative NAA level decreased to 0.40 ± 0.24 during acute stroke and was lost completely 4 days after ictus. Patients with WI showed consistently high rCBV throughout all stages, with residual relative NAA level (0.53 ± 0.25) even at 1 month after symptom onset. Relative lactate level of patients with TI was significantly higher than that of patients with WI at the acute stage (P < .01). Differences in the temporal changes of both rCBV and brain metabolites between TI and WI were significant (P < .01).

CONCLUSION: The different temporal patterns for stroke progression in TI and WI are associated with different evolutions of hemodynamics and neuronal injury.

© RSNA, 2003

Index terms: Brain, infarction, 13.4352, 13.781 • Brain, MR, 13.121413, 13.121414, 13.121416, 13.12143, 13.12144, 13.12145 • Magnetic resonance (MR), perfusion study, 13.12144

This article has been cited by other articles:

				J.M. Provenzale, K. Shah, U. Patel, and D.C. McCrory Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1476 - 1482. [Abstract] [Full Text] [PDF]

				A. B. Singhal, E. Ratai, T. Benner, M. Vangel, V. Lee, W. J. Koroshetz, P. W. Schaefer, A. G. Sorensen, and R. G. Gonzalez Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke Stroke, October 1, 2007; 38(10): 2851 - 2854. [Abstract] [Full Text] [PDF]