Cerebral Blood Flow Threshold of Ischemic Penumbra and Infarct Core in Acute Ischemic Stroke: A Systematic Review
2006; Lippincott Williams & Wilkins; Volume: 37; Issue: 9 Linguagem: Inglês
10.1161/01.str.0000237068.25105.aa
ISSN1524-4628
AutoresTing‐Yim Lee, Blake Murphy, Richard I. Aviv, Allan J. Fox, Sandra E. Black, Demetrios J. Sahlas, Sean Symons, Donald H. Lee, David M. Pelz, Irene Gulka, Richard Chan, Vadim Beletsky, Vladimir Hachinski, Matthew J. Hogan, Mayank Goyal, Andrew M. Demchuk, Shelagh B. Coutts,
Tópico(s)Cerebrovascular and Carotid Artery Diseases
ResumoHomeStrokeVol. 37, No. 9Cerebral Blood Flow Threshold of Ischemic Penumbra and Infarct Core in Acute Ischemic Stroke: A Systematic Review Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBCerebral Blood Flow Threshold of Ischemic Penumbra and Infarct Core in Acute Ischemic Stroke: A Systematic Review Ting-Yim Lee, PhD and Blake D. Murphy, BSc Richard I. Aviv, MD, Allan J. Fox, MD, Sandra E. Black, MD, Demetrios J. Sahlas, MD and Sean Symons, MD Donald H. Lee, MD, David Pelz, MD, Irene B. Gulka, MD, Richard Chan, MD, Vadim Beletsky, MD and Vladimir Hachinski, MD Matthew J. Hogan, MD and Mayank Goyal, MD Andrew M. Demchuk, MD and Shelagh B. Coutts, MD Ting-Yim LeeTing-Yim Lee Lawson Health Research Institute, Robarts Research Institute, London, Canada and Blake D. MurphyBlake D. Murphy Lawson Health Research Institute, Robarts Research Institute, London, Canada Richard I. AvivRichard I. Aviv Sunnybrook Health Sciences Centre, Toronto, Canada , Allan J. FoxAllan J. Fox Sunnybrook Health Sciences Centre, Toronto, Canada , Sandra E. BlackSandra E. Black Sunnybrook Health Sciences Centre, Toronto, Canada , Demetrios J. SahlasDemetrios J. Sahlas Sunnybrook Health Sciences Centre, Toronto, Canada and Sean SymonsSean Symons Sunnybrook Health Sciences Centre, Toronto, Canada Donald H. LeeDonald H. Lee London Health Sciences Centre, London, Canada , David PelzDavid Pelz London Health Sciences Centre, London, Canada , Irene B. GulkaIrene B. Gulka London Health Sciences Centre, London, Canada , Richard ChanRichard Chan London Health Sciences Centre, London, Canada , Vadim BeletskyVadim Beletsky London Health Sciences Centre, London, Canada and Vladimir HachinskiVladimir Hachinski London Health Sciences Centre, London, Canada Matthew J. HoganMatthew J. Hogan Ottawa Health Research Institute, Ottawa, Canada and Mayank GoyalMayank Goyal Ottawa Health Research Institute, Ottawa, Canada Andrew M. DemchukAndrew M. Demchuk Foothills Medical Centre, Calgary, Canada and Shelagh B. CouttsShelagh B. Coutts Foothills Medical Centre, Calgary, Canada Originally published3 Aug 2006https://doi.org/10.1161/01.STR.0000237068.25105.aaStroke. 2006;37:2201Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 3, 2006: Previous Version 1 To the Editor:In the above titled article,1 the authors reviewed 7 published studies that compared cerebral blood flow (CBF) measurements with a diagnostic gold standard (follow-up brain CT/MRI) and reported CBF thresholds for the differentiation between ischemic penumbra and infarct core. They found that the "reported CBF thresholds varied widely, from 14.1 to 35.0 and from 4.8 to 8.4 mL/100 g per minute for penumbra and infarct core, respectively." They concluded that "the use of CBF thresholds… for imaging methods cannot be recommended without further evaluation." Although the caution to await results of further evaluation is correct, there are several aspects of the article that need to be discussed: In the 7 studies reviewed, CBF was measured with positron-emission tomography (PET) in 3 and with perfusion-weighted MRI (PWI) in 4. The analysis and results obtained with these 2 methodologies are very different. PET is quantitative and measures absolute (versus relative) CBF and is the de facto reference standard, whereas CBF measurement with PWI is relative.Within PWI, the methods for calculating CBF can be divided into those that use deconvolution (references 22, 24, and 25 in the article) and those that do not (reference 14 in the article). The 2 analysis methods are significantly different from each other, and there are no published reports on the calibration between the 2 methods.To convert the relative PWI CBF measurements (thresholds) into absolute values as given by PET, the authors scaled the relative values by a factor of 50 mL · min−1 · (100 g)−1. This factor is the normal average value of CBF in younger adults (reference 26 in the article). In contrast, the mean age of subjects in the 4 PWI studies ranged from 64 to 71, and it is known that CBF does decline with age.2,3 Part of the observed variability in threshold can be a consequence of these age-related changes in CBF.In more recent prospective studies involving admission CT perfusion and follow-up CT or MRI to define infarct size, receiver operating characteristic curve or logistic regression analysis has shown that CBF alone is not the optimal CT perfusion parameter to differentiate between ischemic penumbra and infarct core.4,5,6Variability in thresholds in these studies can also be attributable to the type of analysis used. Voxel-based thresholds for infarction are known to be lower than thresholds derived from large region of interest analysis. Both analyses were included in this review.DisclosuresNone.1 Bandera E, Botteri M, Minelli C, Sutton A, Abrams KR, Latronico N. Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke: a systematic review. Stroke. 2006: 37: 1334–1339.LinkGoogle Scholar2 Pantano P, Baron JC, Lebrun-Grandie P, Duquesnoy N, Bousser MG, Comar D. Regional cerebral blood flow and oxygen consumption in human aging. Stroke. 1984; 15: 635–641.CrossrefMedlineGoogle Scholar3 Marchal G, Rioux P, Petit-Taboue MC, Sette G, Travere JM, Le Poec C, Courtheoux P, Derlon JM, Baron JC. Regional cerebral oxygen consumption, blood flow, and blood volume in healthy human aging. Arch Neurol. 1992; 49: 1013–1020.CrossrefMedlineGoogle Scholar4 Murphy BD, Fox AJ, Lee DH, Sahlas DJ, Black SE, Hogan MJ, Coutts SB, Demchuk AM, Goyal M, Aviv RI, Symons S, Gulka IB, Beletsky V, Pelz D, Hachinski V, Chan R, Lee TY. Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements. Stroke. 2006; 37: 1771–1777.LinkGoogle Scholar5 Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, Anderson J, Nesbit G, Gabriely I, Medina V, Quiles A, Pohlman S, Quist M, Schnyder P, Bogousslavsky J, Dillon WP, Pedraza S. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006; 37: 979–985.LinkGoogle Scholar6 Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J, Meuli R. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol. 2002; 51: 417–432.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hoelter P, Muehlen I, Goelitz P, Beuscher V, Schwab S and Doerfler A (2020) Automated ASPECT scoring in acute ischemic stroke: comparison of three software tools, Neuroradiology, 10.1007/s00234-020-02439-3, 62:10, (1231-1238), Online publication date: 1-Oct-2020. Hong S, Yang H, Manaenko A, Lu J, Mei Q and Hu Q (2018) Potential of Exosomes for the Treatment of Stroke, Cell Transplantation, 10.1177/0963689718816990, 28:6, (662-670), Online publication date: 1-Jun-2019. Hoelter P, Schmidt M, Breuer L, Kallmünzer B, Schwab S, Doerfler A and Engelhorn T (2019) Endovascular treatment in patients with large vessel occlusion: reduced mortality despite minimal penumbra, Neuroradiology, 10.1007/s00234-019-02280-3, 61:12, (1469-1476), Online publication date: 1-Dec-2019. Wallmüller C, Spiel A, Sterz F, Schober A, Hubner P, Stratil P and Testori C (2018) Age-dependent effect of targeted temperature management on outcome after cardiac arrest, European Journal of Clinical Investigation, 10.1111/eci.13026, 48:12, (e13026), Online publication date: 1-Dec-2018. Wu D, Lu W, Wei Z, Xu M and Liu X (2018) Neuroprotective Effect of Sirt2-specific Inhibitor AK-7 Against Acute Cerebral Ischemia is P38 Activation-dependent in Mice, Neuroscience, 10.1016/j.neuroscience.2018.01.040, 374, (61-69), Online publication date: 1-Mar-2018. Fox A, Symons S, Howard P, Yeung R and Aviv R (2012) Acute Stroke Imaging: CT with CT Angiography and CT Perfusion before Management Decisions, American Journal of Neuroradiology, 10.3174/ajnr.A3099, 33:5, (792-794), Online publication date: 1-May-2012. Soares B, Dankbaar J, Bredno J, Cheng S, Bhogal S, Dillon W and Wintermark M (2009) Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability, Neuroradiology, 10.1007/s00234-009-0516-9, 51:7, (445-451), Online publication date: 1-Jul-2009. Younts T and Hughes J (2009) Emerging Role of Water Channels in Regulating Cellular Volume During Oxygen Deprivation and Cell Death Brain Hypoxia and Ischemia, 10.1007/978-1-60327-579-8_5, (79-96), . Carinci M, Vezzani B, Patergnani S, Ludewig P, Lessmann K, Magnus T, Casetta I, Pugliatti M, Pinton P and Giorgi C (2021) Different Roles of Mitochondria in Cell Death and Inflammation: Focusing on Mitochondrial Quality Control in Ischemic Stroke and Reperfusion, Biomedicines, 10.3390/biomedicines9020169, 9:2, (169) September 2006Vol 37, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000237068.25105.aaPMID: 16888268 Originally publishedAugust 3, 2006 PDF download Advertisement
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