Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 41, Issue 11, Pages 2916-2927Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X211018317
Keywords
Lactate; metabolism; MRI; neuroradiology; penumbra; stroke
Categories
Funding
- Lundbeck Foundation [R272-2017-4023]
- NIH [P41EBEB013598]
- UCSF NICO project
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Research suggests that hyperpolarized [1-C-13]pyruvate can help identify viable tissue in ischemic stroke patients, potentially increasing access to reperfusion therapy for late presenting patients.
Acute ischemic stroke patients benefit from reperfusion in a short time-window after debut. Later treatment may be indicated if viable brain tissue is demonstrated and this outweighs the inherent risks of late reperfusion. Magnetic resonance imaging (MRI) with hyperpolarized [1-C-13]pyruvate is an emerging technology that directly images metabolism. Here, we investigated its potential to detect viable tissue in ischemic stroke. Stroke was induced in pigs by intracerebral injection of endothelin 1. During ischemia, the rate constant of pyruvate-to-lactate conversion, k(PL), was 52% larger in penumbra and 85% larger in the infarct compared to the contralateral hemisphere (P = 0.0001). Within the penumbra, the k(PL) was 50% higher in the regions that later infarcted compared to non-progressing regions (P = 0.026). After reperfusion, measures of pyruvate-to-lactate conversion were slightly decreased in the infarct compared to contralateral. In addition to metabolic imaging, we used hyperpolarized pyruvate for perfusion-weighted imaging. This was consistent with conventional imaging for assessment of infarct size and blood flow. Lastly, we confirmed the translatability of simultaneous assessment of metabolism and perfusion with hyperpolarized MRI in healthy volunteers. In conclusion, hyperpolarized [1-C-13]pyruvate may aid penumbral characterization and increase access to reperfusion therapy for late presenting patients.
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