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Identifying the ischaemic penumbra using pH-weighted magnetic resonance imaging

Harston, George W. J.; Tee, Yee Kai; Blockley, Nicholas; Okell, Thomas W.; Thandeswaran, Sivarajan; Shaya, Gabriel; Sheerin, Fintan; Cellerini, Martino; Payne, Stephen; Jezzard, Peter; Chappell, Michael; Kennedy, James

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George W. J. Harston

Yee Kai Tee

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Assistant Professor

Thomas W. Okell

Sivarajan Thandeswaran

Gabriel Shaya

Fintan Sheerin

Martino Cellerini

Stephen Payne

Peter Jezzard

Michael Chappell

James Kennedy


© 2014 The Author. The original concept of the ischaemic penumbra suggested imaging of regional cerebral blood flow and metabolism would be required to identify tissue that may benefit from intervention. Amide proton transfer magnetic resonance imaging, a chemical exchange saturation transfer technique, has been used to derive cerebral intracellular pH in preclinical stroke models and has been proposed as a metabolic marker of ischaemic penumbra. In this proof of principle clinical study, we explored the potential of this pH-weighted magnetic resonance imaging technique at tissue-level. Detailed voxel-wise analysis was performed on data from a prospective cohort of 12 patients with acute ischaemic stroke. Voxels within ischaemic core had a more severe intracellular acidosis than hypoperfused tissue recruited to the final infarct (P < 0.0001), which in turn was more acidotic than hypoperfused tissue that survived (P < 0.0001). In addition, when confined to the grey matter perfusion deficit, intracellular pH (P < 0.0001), but not cerebral blood flow (P = 0.31), differed between tissue that infarcted and tissue that survived. Within the presenting apparent diffusion coefficient lesion, intracellular pH differed between tissue with early apparent diffusion lesion pseudonormalization and tissue with true radiographic recovery. These findings support the need for further investigation of pH-weighted imaging in patients with acute ischaemic stroke.

Journal Article Type Article
Acceptance Date Oct 1, 2014
Online Publication Date Dec 29, 2014
Publication Date Jan 1, 2015
Deposit Date Dec 10, 2018
Publicly Available Date Dec 18, 2018
Journal Brain
Print ISSN 0006-8950
Electronic ISSN 1460-2156
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 138
Issue 1
Pages 36-42
Public URL
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