Studies employing CEST MRI to study ischemic stroke focus on the sensitivity of amide proton transfer (APT) MRI signals to tissue pH, assuming identical intracellular protein concentration as healthy tissue. This study shows that whilst cytoplasmic protein concentration remains stable in penumbral stroke regions, it decreases in the infarct core. By analysing APT MRI data with APTR*, which is specifically sensitive to amide proton exchange effects, we demonstrate that the APT signal change in infarct core is dominated by decreased protein concentration, whilst penumbral APT changes can be attributed to decreased tissue pH.
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