Lindsay Gallagher

Potential use of oxygen as a metabolic biosensor in combination with T2*-weighted MRI to define the ischemic penumbra

We describe a novel magnetic resonance imaging technique for detecting metabolism indirectly through changes in oxyhemoglobin:deoxyhemoglobin ratios and T2* signal change during ‘oxygen challenge’ (OC, 5 mins 100% O2). During OC, T2* increase reflects O2 binding to deoxyhemoglobin, which is formed when metabolizing tissues take up oxygen. Here OC has been applied to identify tissue metabolism within the ischemic brain. Permanent middle cerebral artery occlusion was induced in rats. In series 1 scanning (n = 5), diffusion-weighted imaging (DWI) was performed, followed by echo-planar T2* acquired during OC and perfusion-weighted imaging (PWI, arterial spin labeling). Oxygen challenge induced a T2* signal increase of 1.8%, 3.7%, and 0.24% in the contralateral cortex, ipsilateral cortex within the PWI/DWI mismatch zone, and ischemic core, respectively. T2* and apparent diffusion coefficient (ADC) map coregistration revealed that the T2* signal increase extended into the ADC lesion (3.4%). In series 2 (n = 5), FLASH T2* and ADC maps coregistered with histology revealed a T2* signal increase of 4.9% in the histologically defined border zone (55% normal neuronal morphology, located within the ADC lesion boundary) compared with a 0.7% increase in the cortical ischemic core (92% neuronal ischemic cell change, core ADC lesion). Oxygen challenge has potential clinical utility and, by distinguishing metabolically active and inactive tissues within hypoperfused regions, could provide a more precise assessment of penumbra.

Differences in the Evolution of the Ischemic Penumbra in Stroke-Prone Spontaneously Hypertensive and Wistar-Kyoto Rats

Background and Purpose— Stroke-prone spontaneously hypertensive rats (SHRSP) are a highly pertinent stroke model with increased sensitivity to focal ischemia compared with the normotensive reference strain (Wistar-Kyoto rats; WKY). Study aims were to investigate temporal changes in the ischemic penumbra in SHRSP compared with WKY. Methods— Permanent middle cerebral artery occlusion was induced with an intraluminal filament. Diffusion- (DWI) and perfusion- (PWI) weighted magnetic resonance imaging was performed from 1 to 6 hours after stroke, with the PWI-DWI mismatch used to define the penumbra and thresholded apparent diffusion coefficient (ADC) maps used to define ischemic damage. Results— There was significantly more ischemic damage in SHRSP than in WKY from 1 to 6 hours after stroke. The perfusion deficit remained unchanged in WKY (39.9±6 mm2 at 1 hour, 39.6±5.3 mm2 at 6 hours) but surprisingly increased in SHRSP (43.9±9.2 mm2 at 1 hour, 48.5±7.4 mm2 at 6 hours; P=0.01). One hour after stroke, SHRSP had a significantly smaller penumbra (3.4±5.8 mm2) than did WKY (9.7±3.8, P=0.03). In WKY, 56% of the 1-hour penumbra area was incorporated into the ADC lesion by 6 hours, whereas in SHRSP, the small penumbra remained static owing to the temporal increase in both ADC lesion size and perfusion deficit. Conclusions— First, SHRSP have significantly more ischemic damage and a smaller penumbra than do WKY within 1 hour of stroke; second, the penumbra is recruited into the ADC abnormality over time in both strains; and third, the expanding perfusion deficit in SHRSP predicts more tissue at risk of infarction. These results have important implications for management of stroke patients with preexisting hypertension and suggest ischemic damage could progress at a faster rate and over a longer time frame in the presence of hypertension.

Effects of Magnesium Treatment in a Model of Internal Capsule Lesion in Spontaneously Hypertensive Rats

Background and Purpose— The study aim was to assess the effects of magnesium sulfate (MgSO4) administration on white matter damage in vivo in spontaneously hypertensive rats. Methods— The left internal capsule was lesioned by a local injection of endothelin-1 (ET-1; 200 pmol) in adult spontaneously hypertensive rats. MgSO4 was administered (300 mg/kg SC) 30 minutes before injection of ET-1, plus 200 mg/kg every hour thereafter for 4 hours. Infarct size was measured by T2-weighted magnetic resonance imaging (day 2) and histology (day 11), and functional recovery was assessed on days 3 and 10 by the cylinder and walking-ladder tests. Results— ET-1 application induced a small, localized lesion within the internal capsule. Despite reducing blood pressure, MgSO4 did not significantly influence infarct volume (by magnetic resonance imaging: median, 2.1 mm3; interquartile range, 1.3 to 3.8, vs 1.6 mm3 and 1.2 to 2.1, for the vehicle-treated group; by histology: 0.3 mm3 and 0.2 to 0.9 vs 0.3 mm3 and 0.2 to 0.5, respectively). Significant forelimb and hindlimb motor deficits were evident in the vehicle-treated group as late as day 10. These impairments were significantly ameliorated by MgSO4 in both cylinder (left forelimb use, P<0.01 and both-forelimb use, P<0.03 vs vehicle) and walking-ladder (right hindlimb score, P<0.02 vs vehicle) tests. Conclusions— ET-1–induced internal capsule ischemia in spontaneously hypertensive rats represents a good model of lacunar infarct with small lesion size, minimal adverse effects, and a measurable motor deficit. Despite inducing mild hypotension, MgSO4 did not significantly influence infarct size but reduced motor deficits, supporting its potential utility for the treatment of lacunar infarct.

Stroke penumbra defined by an MRI-based oxygen challenge technique: 1. Validation using [14C]2-deoxyglucose autoradiography

Accurate identification of ischemic penumbra will improve stroke patient selection for reperfusion therapies and clinical trials. Current magnetic resonance imaging (MRI) techniques have limitations and lack validation. Oxygen challenge T*2 MRI (T*2 OC) uses oxygen as a biotracer to detect tissue metabolism, with penumbra displaying the greatest T*2 signal change during OC. [14C]2-deoxyglucose (2-DG) autoradiography was combined with T*2 OC to determine metabolic status of T*2-defined penumbra. Permanent middle cerebral artery occlusion was induced in anesthetized male Sprague-Dawley rats (n = 6). Ischemic injury and perfusion deficit were determined by diffusion- and perfusion-weighted imaging, respectively. At 147 ± 32 minutes after stroke, T*2 signal change was measured during a 5-minute 100% OC, immediately followed by 125 μCi/kg 2-DG, intravenously. Magnetic resonance images were coregistered with the corresponding autoradiograms. Regions of interest were located within ischemic core, T*2-defined penumbra, equivalent contralateral structures, and a region of hyperglycolysis. A T*2 signal increase of 9.22% ± 3.9% (mean ± s.d.) was recorded in presumed penumbra, which displayed local cerebral glucose utilization values equivalent to contralateral cortex. T*2 signal change was negligible in ischemic core, 3.2% ± 0.78% in contralateral regions, and 1.41% ± 0.62% in hyperglycolytic tissue, located outside OC-defined penumbra and within the diffusion abnormality. The results support the utility of OC-MRI to detect viable penumbral tissue following stroke.

Impaired functional recovery after stroke in the stroke-prone spontaneously hypertensive rat.

Background and Purpose— To identify if the stroke-prone spontaneously hypertensive rat (SHRSP) exhibits impaired functional recovery after stroke compared with its normotensive reference strain, the Wistar Kyoto rat (WKY). Methods— In study 1, a 2-mm distal middle cerebral artery occlusion (middle cerebral artery occlusion) was performed in both strains and recovery assessed using a 33-point neurological score. Because SHRSPs displayed much larger infarcts than WKYs, study 2 and study 3 involved extending the length of middle cerebral artery (MCA) occlusion in the WKY to increase the volume and distribution of infarction to comparable levels with SHRSP. Animals were assessed with the neurological score, tapered beam walk, and cylinder tests. Results— In study 1, infarct volume (expressed as a percent of contralateral hemisphere) was WKY 13.1±3% and SHRSP 19.8±1%. Initial neurological deficit was greater (WKY 25±1, SHRSP 22±1, out of a possible 33) and subsequent recovery was poorer in SHRSP. In studies 2 and 3, infarct volume and distribution (study 2, WKY 21.8±1.3%, SHRSP 22.9±3%; study 3, WKY 17.2±2%, SHRSP 16.5±3%) and initial neurological deficit at 2 hours after middle cerebral artery occlusion (study 2 WKY 23±1, SHRSP 22±2; study 3 WKY 25±1 and SHRSP 23±1; mean±SEM) were comparable between strains. However, whereas WKY recovered toward normal scores, SHRSP scored significantly lower 2 weeks (study 2) and 4 weeks (study 3) after middle cerebral artery occlusion. Beam walk data revealed long-term impairment in SHRSP contralateral limb use, compared with WKY, at days 3, 7, and 28 (P<0.05). Conclusions— SHRSP exhibit impaired functional recovery after stroke compared with WKY.

Stroke Penumbra Defined by an MRI-Based Oxygen Challenge Technique: 2. Validation based on the Consequences of Reperfusion:

Magnetic resonance imaging (MRI) with oxygen challenge (T*2 OC) uses oxygen as a metabolic biotracer to define penumbral tissue based on CMRO2 and oxygen extraction fraction. Penumbra displays a greater T*2 signal change during OC than surrounding tissue. Since timely restoration of cerebral blood flow (CBF) should salvage penumbra, T*2 OC was tested by examining the consequences of reperfusion on T*2 OC-defined penumbra. Transient ischemia (109 ± 20 minutes) was induced in male Sprague-Dawley rats (n = 8). Penumbra was identified on T*2-weighted MRI during OC. Ischemia and ischemic injury were identified on CBF and apparent diffusion coefficient maps, respectively. Reperfusion was induced and scans repeated. T2 for final infarct and T*2 OC were run on day 7. T*2 signal increase to OC was 3.4% in contralateral cortex and caudate nucleus and was unaffected by reperfusion. In OC-defined penumbra, T*2 signal increased by 8.4% ± 4.1% during ischemia and returned to 3.25% ± 0.8% following reperfusion. Ischemic core T*2 signal increase was 0.39% ± 0.47% during ischemia and 0.84% ± 1.8% on reperfusion. Penumbral CBF increased from 41.94 ± 13 to 116.5 ± 25 mL per 100 g per minute on reperfusion. On day 7, OC-defined penumbra gave a normal OC response and was located outside the infarct. T*2 OC-defined penumbra recovered when CBF was restored, providing further validation of the utility of T*2 OC for acute stroke management.

A double-tuned 1H/23Na dual resonator system for tissue sodium concentration measurements in the rat brain via Na-MRI

A method for quantifying the tissue sodium concentration (TSC) in the rat brain from ²³Na-MR images was developed. TSC is known to change in a variety of common human diseases and holds considerable potential to contribute to their study; however, its accurate measurement in small laboratory animals has been hindered by the extremely low signal to noise ratio (SNR) in ²³Na images. To address this, the design, construction and characterization of a double-tuned ¹H/²³Na dual resonator system for ¹H-guided quantitative ²³Na-MRI are described. This system comprises an SNR-optimized surface detector coil for ²³Na image acquisition, and a volume resonator producing a highly homogeneous B₁ field (<5% inhomogeneity) for the Na channel across the rat head. The resonators incorporated channel-independent balanced matching and tuning capabilities with active decoupling circuitry at the ²³Na resonance frequency. A quantification accuracy of TSC of <10 mM was achieved in Na-images with 1.2 µl voxel resolution acquired in 10 min. The potential of the quantification technique was demonstrated in an in vivo experiment of a rat model of cerebral stroke, where the evolution of the TSC was successfully monitored for 8 h after the stroke was induced.

Regional and temporal variations in tissue sodium concentration during the acute stroke phase

A technique for noninvasively quantifying the concentration of sodium (23Na) ions was applied to the study of ischemic stroke. 23Na‐magnetic resonance imaging techniques have shown considerable potential for measuring subtle changes in ischemic tissue, although studies to date have suffered primarily from poor signal/noise ratio. In this study, accurate quantification of tissue sodium concentration (TSC) was achieved in 23Na images with voxel sizes of 1.2 μL acquired in 10 min. The evolution of TSC was investigated from 0.5 to 8 h in focal cortical and subcortical ischemic tissue following permanent middle cerebral artery occlusion in the rat (n = 5). Infarct volumes determined from TSC measurements correlated significantly with histology (P = 0.0006). A delayed linear model was fitted to the TSC time course data in each voxel, which revealed that the TSC increase was more immediate (0.2 ± 0.1 h delay time) in subcortical ischemic tissue, whereas it was delayed by 1.6 ± 0.5 h in ischemic cortex (P = 0.0002). No significant differences (P = 0.5) were measured between TSC slope rates in cortical (10.2 ± 1.1 mM/h) and subcortical (9.7 ± 1.1 mM/h) ischemic tissue. The data suggest that any TSC increase measured in ischemic tissue indicates infarction (core) and regions exhibiting a delay to TSC increase indicate potentially salvageable tissue (penumbra). Magn Reson Med, 2012.

Novel MRI detection of the ischemic penumbra: direct assessment of metabolic integrity

We describe a novel magnetic resonance imaging technique to directly assess the metabolic integrity of penumbral tissue following stroke. For ischemically stressed tissue to be salvageable, it has to be capable of recovering aerobic metabolism (in place of anaerobic metabolism) on reperfusion. We probed ischemic brain tissue by altering the rate of oxygen delivery using a challenge of 100% oxygen ventilation. Any change from anaerobic to aerobic metabolism should alter the rate of lactate production and hence, levels of tissue lactate. Stroke was induced by permanent middle cerebral artery occlusion in rats. In Series 1 (n = 6), changes in tissue lactate during and following 100% oxygen challenge were monitored using 1H magnetic resonance spectroscopy (MRS). Diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) were used to locate MRS voxels within the ischemic core, the homotopic contralateral striatum and within PWI/DWI mismatch (i.e. presumed penumbra). After 20 min of oxygen, lactate signal change was −16.1 ± 8.8% (mean ± SD) in PWI/DWI mismatch, +2.8 ± 5.1% in the ischemic core, and −0.6 ± 7.6% in the contralateral striatum. Return to air ventilation for 20 min resulted in a reversal, with lactate increasing by 46 ± 25.3% in the PWI/DWI mismatch, 6.6 ± 6.2% in the ischemic core, and −5 ± 11.4% in the contralateral striatum. In Series 2 (n = 6), a novel form of spectroscopic imaging was used to acquire lactate change maps to spatially identify regions of lactate change within the ischemic brain. This technique has potential clinical utility by identifying tissue that displays anaerobic metabolism capable of recovering aerobic metabolism when oxygen delivery is increased, which could provide a more precise assessment of penumbra. Copyright

The design of a double-tuned two-port surface resonator and its application to in vivo Hydrogen- and Sodium-MRI

The design and construction of a two-port surface transceiver resonator for both (1)H-and (23)Na-MRI in the rodent brain at 7 T is described. Double-tuned resonators are required for accurately co-registering multi-nuclei data sets, especially when the time courses of (1)H and (23)Na signals are of interest as, for instance, when investigating the pathological progression of ischaemic stroke tissue in vivo. In the current study, a single-element two-port surface resonator was developed wherein both frequency components were measured with the same detector element but with each frequency signal routed along different output channels. This was achieved by using the null spot technique, allowing for optimal variable tuning and matching of each channel in situ within the MRI scanner. The (23)Na signal to noise ratio, measured in the ventricles of the rat brain, was increased by a factor of four compared to recent state-of-the-art rat brain studies reported in the literature. The resonators performance was demonstrated in an in vivo rodent stroke model, where regional variations in (1)H apparent diffusion coefficient maps and the (23)Na signal were recorded in an interleaved fashion as a function of time in the acute phase of the stroke without having to exchange, re-adjust, or re-connect resonators between scans. Using the practical construction steps described in this paper, this coil design can be easily adapted for MRI of other X-nuclei, such as (17)O, (13)C, (39)K, and (43)Ca at various field strengths.