A Method for Imaging the Ischemic Penumbra with MRI using IVIM

TL;DR

This study demonstrates that IVIM MRI can effectively quantify cerebral blood flow and define ischemic penumbra, correlating well with DSC MRI and predicting infarct volume and growth in acute stroke models.

Contribution

It introduces a novel IVIM MRI method for imaging ischemic penumbra and compares its effectiveness with established DSC MRI techniques in a pre-clinical stroke model.

Findings

IVIM qCBF strongly correlates with DSC qCBF.

Both IVIM and DSC perfusion measures predict final infarct volume.

IVIM PWI/DWI ratio correlates with infarct growth.

Abstract

This work examines the hypothesis that intravoxel incoherent motion MRI (IVIM) can quantify local cerebral blood flow (qCBF), infarct volume, and define the ischemic penumbra for determination of the perfusion-diffusion mismatch (PWI/DWI) volume in a setting of acute ischemic stroke. Eight experiments were conducted in a pre-clinical middle cerebral artery occlusion (MCAO) model. IVIM and dynamic susceptibility contrast (DSC) imaging were acquired 2.5hr post-MCAO. IVIM was post-processed using software written in-house to produce parametric images of local qCBF, Water Transport Time (WTT), diffusion, and subsequently, PWI/DWI mismatch. These IVIM image parameters were compared with delay-and-dispersion-corrected local-AIF DSC perfusion image parameters including Tmax, qCBF, mean transit time (MTT), and mean diffusivity for DSC PWI/DWI mismatch. Final infarct volume was measured 4hrs post-occlusion. Early (2.5hr post-occlusion) DSC qCBF and IVIM qCBF in the diffusion negative MCA territory correlated strongly (slope=1.00, p=0.01,R2=0.69,Lins CCC=0.71), and both DSC and IVIM qCBF values negatively correlated with final infarct volume (R2=0.78,R2=0.61 respectively). The volume of hypoperfusion measured at 2.5 hours from DSC qCBF and from IVIM qCBF both predicted final infarct volume with good sensitivity and correlation (slope=2.08, R2=0.67, slope=2.50,R2=0.68 respectively). IVIM PWI/DWI ratio was correlated with infarct growth (R2=0.70) and WTT correlated with MTT (slope=0.82,R2=0.60). IVIM qCBF correlated strongly with local-AIF DSC qCBF and IVIM PWI/DWI correlated strongly with infarct growth. Both DSC and IVIM quantitative perfusion image acquired early after occlusion were able to predict final infarct volume, and IVIM simultaneous PWI/DWI ratio predicted infarct growth.