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A comprehensive analysis of metabolic changes in the salvaged penumbra

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Abstract

Introduction

We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery.

Methods

One hundred ten anterior circulation ischemic stroke patients presenting to hospital within 4.5 h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24 h after stroke onset, including single-voxel, short-echo-time (30 ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area.

Results

The concentrations of total creatine (5.39 vs 5.85 mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13 mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24 h (r 2 = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24 h (r 2 = 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001).

Conclusion

Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24 h and greater disability at 3 months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.

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Authors and Affiliations

  1. Department of Neurology, John Hunter Hospital, University of Newcastle, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia

    Andrew Bivard, Venkatesh Krishnamurthy, Longting Lin, Christopher Levi, Neil J. Spratt, Ferdi Mittef & Mark Parsons

  2. Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia

    Nawaf Yassi & Stephen Davis

Authors
  1. Andrew Bivard
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  2. Nawaf Yassi
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  3. Venkatesh Krishnamurthy
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  4. Longting Lin
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  5. Christopher Levi
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  6. Neil J. Spratt
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  7. Ferdi Mittef
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  8. Stephen Davis
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  9. Mark Parsons
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Corresponding author

Correspondence to Andrew Bivard.

Ethics declarations

We declare that all human and animal studies have been approved by the Hunter New England Human Research Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Bivard, A., Yassi, N., Krishnamurthy, V. et al. A comprehensive analysis of metabolic changes in the salvaged penumbra. Neuroradiology 58, 409–415 (2016). https://doi.org/10.1007/s00234-015-1638-x

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  • DOI: https://doi.org/10.1007/s00234-015-1638-x

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