Research Progress in Defining Ischemic Penumbra in Acute Stroke Based on Magnetic Resonance Metabolic Techniques

DOI: https://doi.org/10.62517/jmhs.202505225

Author(s)

Yuling Qiao1,2, Haiyan Sang3, Furong Deng1, Yonghai Zhang1,2, Gang Shi1

Affiliation(s)

1School of Clinical Medicine,Qinghai University, Xining, Qinghai, China 2Qing hai Provincial People's Hospital, Xining, Qinghai, China 3Qinghai Provincial Traffic Hospital, Xining, Qinghai, China

Abstract

The onset time window of ischemic stroke patients is often unclear. Whether they can benefit from reperfusion therapies such as thrombolysis or thrombectomy depends on the presence of an ischemic penumbra (IP). Therefore, for stroke patients where every minute counts, the identification of IP must be not only rapid and accurate but also easy for clinicians to understand. A large number of studies have shown that IP defined based on perfusion thresholds is insufficiently accurate. The true IP is a dynamically evolving process, referring to tissues whose cellular structure has not been destroyed and can be salvaged. Its inner and outer boundaries can only be truly and accurately reflected at the molecular level of cellular metabolism.To this end, emerging magnetic resonance metabolic detection technologies have focused on various metabolic parameters in stroke patients, such as tissue pH value, oxygen extraction fraction (OEF), lactate (Lac), phosphocreatine (PCr), etc. Amide proton transfer imaging (APTw) is used to accurately detect changes in tissue pH values to understand tissue metabolic information. Magnetic resonance quantitative susceptibility mapping (QSM, CAT-QQ) can detect OEF to assess tissue oxygen metabolic status. Fast high-resolution magnetic resonance spectroscopic imaging (MRSI) combined with SPICE (SPectroscopic Imaging by exploiting spatiospectral CorrElation) technology enables in vivo, non-invasive multi-molecular synchronous imaging, making tissue metabolic conditions clear at a glance. Additionally, high-field multinuclear magnetic resonance technology can observe substances such as sodium ions and glucose, providing more accurate and detailed physiological and metabolic information at the molecular level. This article reviews the research status of the above physiological and metabolic parameters in defining IP.

Keywords

Metabolic Magnetic Resonance; Ischemic Penumbra; Artificial Intelligence

References

[1]Guidelines for the Prevention and Treatment of Cerebrovascular Diseases (2024 Edition). Magnetic Resonance Imaging. : 1-8. [2] SYMON L, BRANSTON N M, STRONG A J, et al. The concepts of thresholds of ischaemia in relation to brain structure and function[J]. J Clin Pathol Suppl (R Coll Pathol), 1977,11:149-154. [3] LEIGH R, KNUTSSON L, ZHOU J, et al. Imaging the physiological evolution of the ischemic penumbra in acute ischemic stroke[J]. J Cereb Blood Flow Metab, 2018,38(9):1500-1516. [4] PLUM F. What causes infarction in ischemic brain?: The Robert Wartenberg Lecture[J]. Neurology, 1983,33(2):222-233. [5] J A, B K S, L S. Thresholds in cerebral ischemia - the ischemic penumbra[J]. Stroke, ,12(6):723-725. [6] JOSé, CASTILLO, AND, et al. Progression of ischaemic stroke and excitotoxic aminoacids[J]. Lancet, 1997. [7] BARON J C. Mapping the ischaemic penumbra with PET: a new approach[J]. Brain: A journal of neurology, 2001,124(Pt.1):2-4. [8] WOLF-DIETER H. The concept of the penumbra: can it be translated to stroke management?[J]. International Journal of Stroke, 2010,5(4):290-295. [9] K A H. Viability thresholds and the penumbra of focal ischemia[J]. Ann Neurol, 1994,36(4):557-565. [10] GUADAGNO J V, DONNAN G A, MARKUS R, et al. Imaging the ischaemic penumbra[J]. Curr Opin Neurol, 2004,17(1):61-67. [11] GEORGE W J H, YEE KAI T, NICHOLAS B, et al. Identifying the ischaemic penumbra using pH-weighted magnetic resonance imaging[J]. BRAIN, 2015,138(Pt 1):36-42. [12] JIAN Z, HONGMEI Z, PEIYI G, et al. Assessment of perihematomal hypoperfusion injury in subacute and chronic intracerebral hemorrhage by CT perfusion imaging[J]. Neurol Res, 2010,32(6):642-649. [13] ROSAND J, ESKEY C, CHANG Y, et al. Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage[J]. Cerebrovasc Dis, 2002,14(3/4):214-220. [14] PASCHEN W, MIES G, HOSSMANN K A. Threshold relationship between cerebral blood flow, glucose utilization, and energy metabolites during development of stroke in gerbils[J]. Exp Neurol, 1992,117(3):325-333. [15] ALLEN K, BUSZA A L, CROCKARD H A, et al. Acute cerebral ischaemia: concurrent changes in cerebral blood flow, energy metabolites, pH, and lactate measured with hydrogen clearance and 31P and 1H nuclear magnetic resonance spectroscopy. III. Changes following ischaemia[J]. Journal of Cerebral Blood Flow & Metabolism Official Journal of the International Society of Cerebral Blood Flow & Metabolism, 1988,8(6):816. [16] Acute cerebral ischaemia: concurrent changes in cerebral blood flow, energy metabolites, pH, and lactate measured with hydrogen clearance and 31P and 1H nuclear magnetic resonance spectroscopy. I. Methodology[J]. J Cereb Blood Flow Metab, 1987,7(2):199-206. [17] KAMBIZ N, ARASH M, DAVID S L, et al. Quantitative analysis of hypoperfusion in acute stroke: arterial spin labeling versus dynamic susceptibility contrast[J]. Stroke, 2013,44(11):3090-3096. [18] ZHOU J, LAL B, WILSON D A, et al. Amide proton transfer (APT) contrast for imaging of brain tumors[J]. Magnetic resonance in medicine: official journal of the Society of Magnetic Resonance in Medicine, 2003,50(6):1120-1126. [19] JINYUAN Z, JEAN-FRANCOIS P, DAVID A W, et al. Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI[J]. Nat Med, 2003,9(8):1085-1090. [20] HU F X, TONG T, PENG W J. Research Progress of Chemical Exchange Saturation Transfer MRI in Tumor Research[J]. Chinese Journal of Radiology, 2022,56(10):1149-1154.