Defining the Ischemic Penumbra Using Hyperacute Neuroimaging: Deriving Quantitative Ischemic Thresholds

Despite three decades of promise, a neuroimaging biomarker capable of delineating the ischemic penumbra is yet to be definitively demonstrated. Much progress has been made, especially with MR imaging. However, in order to rigorously define an imaging biomarker of the ischemic penumbra, carefully designed studies which can derive ischemic thresholds using quantitative imaging parameters may be required. Two thresholds are of interest: one which distinguishes the ischemic core from penumbra, and another which distinguishes the penumbra from benign oligemia. In this review, we discuss one possible approach to define these thresholds by following tissue fate in the presence or absence of early reperfusion.