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

Yi Jui Liu, Cheng Yu Chen, Hsiao Wen Chung, Ing Jye Huang, Chang Shin Lee, Shy Chyi Chin, Michelle Liou

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)366-374
Number of pages9
JournalRadiology
Volume229
Issue number2
DOIs
Publication statusPublished - Nov 2003
Externally publishedYes

Fingerprint

Magnetic Resonance Angiography
Infarction
Wounds and Injuries
Stroke
Lactic Acid
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Brain
Contrast Media
Analysis of Variance
Hemodynamics

Keywords

  • Brain, infarction
  • Brain, MR
  • Magnetic resonance (MR), perfusion study

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory : Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging. / Liu, Yi Jui; Chen, Cheng Yu; Chung, Hsiao Wen; Huang, Ing Jye; Lee, Chang Shin; Chin, Shy Chyi; Liou, Michelle.

In: Radiology, Vol. 229, No. 2, 11.2003, p. 366-374.

Research output: Contribution to journalArticle

Liu, Yi Jui ; Chen, Cheng Yu ; Chung, Hsiao Wen ; Huang, Ing Jye ; Lee, Chang Shin ; Chin, Shy Chyi ; Liou, Michelle. / Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory : Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging. In: Radiology. 2003 ; Vol. 229, No. 2. pp. 366-374.
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abstract = "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.",
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T1 - Neuronal Damage after Ischemic Injury in the Middle Cerebral Arterial Territory

T2 - Deep Watershed versus Territorial Infarction at MR Perfusion and Spectroscopic Imaging

AU - Liu, Yi Jui

AU - Chen, Cheng Yu

AU - Chung, Hsiao Wen

AU - Huang, Ing Jye

AU - Lee, Chang Shin

AU - Chin, Shy Chyi

AU - Liou, Michelle

PY - 2003/11

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N2 - 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.

AB - 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.

KW - Brain, infarction

KW - Brain, MR

KW - Magnetic resonance (MR), perfusion study

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