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A PET-Guided Framework Supports a Multiple Arterial Input Functions Approach in DSC-MRI in Acute Stroke

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DOI

  • Michelle Livne, Charite, Charite Medical University of Berlin, Humboldt University of Berlin, Free University of Berlin, Ctr Stroke Res Berlin CSB
  • ,
  • Vince I. Madai, Charite, Charite Medical University of Berlin, Humboldt University of Berlin, Free University of Berlin, Ctr Stroke Res Berlin CSB
  • ,
  • Peter Brunecker, Charite, Charite Medical University of Berlin, Humboldt University of Berlin, Free University of Berlin, Ctr Stroke Res Berlin CSB
  • ,
  • Olivier Zaro-Weber, Max Planck Inst Neurol Res, Max Planck Society
  • ,
  • Walter Moeller-Hartmann, Ludmillenstift Meppen, Dept Radiol
  • ,
  • Wolf-Dieter Heiss
  • ,
  • Kim Mouridsen
  • Jan Sobesky, Charite, Charite Medical University of Berlin, Humboldt University of Berlin, Free University of Berlin, Ctr Stroke Res Berlin CSB

BACKGROUND AND PURPOSE: In acute stroke, arterial-input-function (AIF) determination is essential for obtaining perfusion estimates with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI). Standard DSC-MRI postprocessing applies single AIF selection, ie, global AIF. Physiological considerations, however, suggest that a multiple AIFs selection method would improve perfusion estimates to detect penumbral flow. In this study, we developed a framework based on comparable DSC-MRI and positron emission tomography (PET) images to compare the two AIF selection approaches and assess their performance in penumbral flow detection in acute stroke.

METHODS: In a retrospective analysis of 17 sub(acute) stroke patients with consecutive MRI and PET scans, voxel-wise optimized AIFs were calculated based on the kinetic model as derived from both imaging modalities. Perfusion maps were calculated based on the optimized-AIF using two methodologies: (1) Global AIF and (2) multiple AIFs as identified by cluster analysis. Performance of penumbral-flow detection was tested by receiver-operating characteristics (ROC) curve analysis, ie, the area under the curve (AUC).

RESULTS: Large variation of optimized AIFs across brain voxels demonstrated that there is no optimal single AIF. Subsequently, the multiple-AIF method (AUC range over all maps:.82-. 90) outperformed the global AIF methodology (AUC.72-. 85) significantly.

CONCLUSIONS: We provide PET imaging-based evidence that a multiple AIF methodology is beneficial for penumbral flow detection in comparison with the standard global AIF methodology in acute stroke.

Original languageEnglish
JournalJournal of Neuroimaging
Volume27
Issue5
Pages (from-to)486-492
Number of pages7
ISSN1051-2284
DOIs
Publication statusPublished - 2017

    Research areas

  • Arterial input function, DSC-MRI, local AIF, PET, PWI, CEREBRAL-BLOOD-FLOW, POSITRON-EMISSION-TOMOGRAPHY, SINGULAR-VALUE DECOMPOSITION, SUSCEPTIBILITY CONTRAST MRI, HIGH-RESOLUTION MEASUREMENT, TRACER BOLUS PASSAGES, ACUTE ISCHEMIC-STROKE, PERFUSION MRI, DECONVOLUTION TECHNIQUES, AUTOMATIC SELECTION

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