- Title
- A comprehensive analysis of metabolic changes in the salvaged penumbra
- Creator
- Bivard, Andrew; Yassi, Nawaf; Krishnamurthy, Venkatesh; Lin, Longting; Levi, Christopher; Spratt, Neil J.; Mittef, Ferdi; Davis, Stephen; Parsons, Mark
- Relation
- Neuroradiology Vol. 58, Issue 4, p. 409-415
- Publisher Link
- http://dx.doi.org/10.1007/s00234-015-1638-x
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2016
- Description
- Introduction: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery. Methods: One hundred ten anterior circulation ischemic stroke patients presenting to hospital within 4.5 h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24 h after stroke onset, including single-voxel, short-echo-time (30 ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area. Results: The concentrations of total creatine (5.39 vs 5.85 mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13 mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24 h (r² = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24 h (r²= 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001). Conclusion: Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24 h and greater disability at 3 months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.
- Subject
- spectroscopy; penumbra; clinical outcome; glutamate; ischemic stroke
- Identifier
- http://hdl.handle.net/1959.13/1316167
- Identifier
- uon:23095
- Identifier
- ISSN:0028-3940
- Language
- eng
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