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Yang T, Peng P, Jiang S, Yan Y, Hu Y, Wang H, Ye C, Pan R, Sun J, Wu B. Multiple Hypointense Vessels are Associated with Cognitive Impairment in Patients with Single Subcortical Infarction. Transl Stroke Res 2023:10.1007/s12975-023-01206-9. [PMID: 38051469 DOI: 10.1007/s12975-023-01206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
We aimed to explore the relationship between multiple hypointense vessels and cognitive function in patients with single subcortical infarction (SSI) and the role of SSI with different etiological mechanisms in the above relationship. Multiple hypointense vessels were measured by the number of deep medullary veins (DMVs), DMVs score, and cortical veins (CVs) score. The Montreal Cognitive Assessment (MoCA), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) were assessed to evaluate cognitive function. SSI was dichotomized as branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI by whole-brain vessel-wall magnetic resonance imaging. We included a total of 103 acute SSI patients. After adjustments were made for related risk factors of cognitive function, the SSI patients with higher DMVs score were more likely to have longer STT-B (P = 0.001) and smaller STT-B-1 min (P = 0.014), and the SSI patients with higher CVs score were more likely to have shorter STT-A (P = 0.049). In subgroup analysis, we found that the negative relationship between DMVs scores and cognitive function and the positive relationship between CVs scores and cognitive function were significantly stronger in BAD patients. We provided valuable insights into the associations between DMVs, CVs, and multi-domain cognitive impairment in SSI patients, which underscored the necessity to further study the dynamic alterations of venules and their specific influence on post-stroke cognitive impairment.
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Affiliation(s)
- Tang Yang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Pengfei Peng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Yi Hu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ruosu Pan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
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Lee J, Lee HJ, Ha SY, Kim HC, Kang Y, Jin SC, Park S. Assessment of thrombus using susceptibility-weighted filtered-phase images in patients with acute ischemic stroke. J Neuroimaging 2023; 33:147-155. [PMID: 36068702 DOI: 10.1111/jon.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Recognizing the location and length of the thrombus responsible for large vessel occlusion in patients with acute ischemic stroke can facilitate effective endovascular recanalization therapy (ERT). We hypothesized that the aliasing or dipole effect produced by filtered-phase susceptibility-weighted imaging (SWI) would facilitate thrombus delineation. METHODS Of the patients with middle cerebral artery occlusion who underwent ERT, we screened those who underwent noncontrast CT (NCCT), multiphase CT angiography (mCTA), and SWI before the endovascular procedure. We used an arbitrary index termed measurement of equivalence in thrombus assessed by digital subtraction angiography (METAD) defined as having the same location as the thrombus observed in the digital subtraction angiography (DSA) and length differing by less than 5 mm. For NCCT, mCTA, SWI_m (magnitude), and SWI_p (phase), the length of the thrombus and METAD were assessed. RESULTS The mean lengths of the thrombi determined using NCCT, mCTA, SWI_m, SWI_p, and DSA were 14.03, 13.47, 13.89, 9.93, and 8.96 mm, respectively. The absolute agreement for thrombus length was excellent for SWI_p and DSA (intraclass correlation coefficient [ICC] = .96), moderate for SWI_m and DSA (ICC = .53), and poor for mCTA and DSA (ICC = .14). The METADs were 26.7%, 40.0%, 33.3%, and 73.3% for NCCT, mCTA, SWI_m, and SWI_p, respectively. The METADs for NCCT and SWI_p were significantly different (p = .045) and those for mCTA and SWI_m were not (p = .537 and .093, respectively). CONCLUSIONS The SWI_p was best matched with the DSA for the measurement of the lengths and locations of thrombi. The use of pre-thrombectomy SWI_p imaging for acute ischemic stroke may facilitate a successful ERT strategy.
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Affiliation(s)
- Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sam Yeol Ha
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Li C, Rusinek H, Chen J, Bokacheva L, Vedvyas A, Masurkar AV, Haacke EM, Wisniewski T, Ge Y. Reduced white matter venous density on MRI is associated with neurodegeneration and cognitive impairment in the elderly. Front Aging Neurosci 2022; 14:972282. [PMID: 36118685 PMCID: PMC9475309 DOI: 10.3389/fnagi.2022.972282] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
High-resolution susceptibility weighted imaging (SWI) provides unique contrast to small venous vasculature. The conspicuity of these mesoscopic veins, such as deep medullary veins in white matter, is subject to change from SWI venography when venous oxygenation in these veins is altered due to oxygenated blood susceptibility changes. The changes of visualization in small veins shows potential to depict regional changes of oxygen utilization and/or vascular density changes in the aging brain. The goal of this study was to use WM venous density to quantify small vein visibility in WM and investigate its relationship with neurodegenerative features, white matter hyperintensities (WMHs), and cognitive/functional status in elderly subjects (N = 137). WM venous density was significantly associated with neurodegeneration characterized by brain atrophy (β = 0.046± 0.01, p < 0.001), but no significant association was found between WM venous density and WMHs lesion load (p = 0.3963). Further analysis of clinical features revealed a negative trend of WM venous density with the sum-of-boxes of Clinical Dementia Rating and a significant association with category fluency (1-min animal naming). These results suggest that WM venous density on SWI can be used as a sensitive marker to characterize cerebral oxygen metabolism and different stages of cognitive and functional status in neurodegenerative diseases.
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Affiliation(s)
- Chenyang Li
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, United States
| | - Henry Rusinek
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Jingyun Chen
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Louisa Bokacheva
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Alok Vedvyas
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Arjun V. Masurkar
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - E. Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Thomas Wisniewski
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
- Departments of Pathology, NYU Grossman School of Medicine, New York, NY, United States
| | - Yulin Ge
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
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Cao F, Wang M, Fan S, Han S, Guo Y, Zaman A, Guo J, Luo Y, Kang Y. Cerebral Venous Oxygen Saturation in Hypoperfusion Regions May Become a New Imaging Indicator to Predict the Clinical Outcome of Stroke. Life (Basel) 2022; 12:life12091312. [PMID: 36143349 PMCID: PMC9504954 DOI: 10.3390/life12091312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
To automatically and quantitatively evaluate the venous oxygen saturation (SvO2) in cerebral ischemic tissues and explore its value in predicting prognosis. A retrospective study was conducted on 48 AIS patients hospitalized in our hospital from 2015−2018. Based on quantitative susceptibility mapping and perfusion-weighted imaging, this paper measured the cerebral SvO2 in hypoperfusion tissues and its change after intraarterial rt-PA treatment. The cerebral SvO2 in different hypoperfusion regions between the favorable and unfavorable clinical outcome groups was analyzed using an independent t-test. Relationships between cerebral SvO2 and clinical scores were determined using the Pearson correlation coefficient. The receiver operating characteristic process was conducted to evaluate the accuracy of cerebral SvO2 in predicting unfavorable clinical outcomes. Cerebral SvO2 in hypoperfusion (Tmax > 4 and 6 s) was significantly different between the two groups at follow-up (p < 0.05). Cerebral SvO2 and its changes before and after treatment were negatively correlated with clinical scores. The positive predictive value, negative predictive value, accuracy, and area under the curve of the cerebral SvO2 were higher than those predicted by the ischemic core. Therefore, the cerebral SvO2 of hypoperfusion regions was a stronger imaging predictor of unfavorable clinical outcomes after stroke.
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Affiliation(s)
- Fengqiu Cao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
| | - Mingming Wang
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Shengyu Fan
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
| | - Shanhua Han
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Yingwei Guo
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
| | - Asim Zaman
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
- Engineering Research Centre of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang 110169, China
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, NY 10027, USA
- Correspondence: (J.G.); (Y.L.); (Y.K.); Tel.: +86-139-4047-2926 (Y.K.)
| | - Yu Luo
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
- Correspondence: (J.G.); (Y.L.); (Y.K.); Tel.: +86-139-4047-2926 (Y.K.)
| | - Yan Kang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
- Engineering Research Centre of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang 110169, China
- School of Applied Technology, Shenzhen University, Shenzhen 518060, China
- Correspondence: (J.G.); (Y.L.); (Y.K.); Tel.: +86-139-4047-2926 (Y.K.)
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Cao F, Wang M, Han S, Fan S, Guo Y, Yang Y, Luo Y, Guo J, Kang Y. Quantitative Distribution of Cerebral Venous Oxygen Saturation and Its Prognostic Value in Patients with Acute Ischemic Stroke. Brain Sci 2022; 12:brainsci12081109. [PMID: 36009171 PMCID: PMC9406002 DOI: 10.3390/brainsci12081109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated the quantitative distribution of cerebral venous oxygen saturation (SvO2) based on quantitative sensitivity mapping (QSM) and determined its prognostic value in patients with acute ischemic stroke (AIS). A retrospective study was conducted on 39 hospitalized patients. Reconstructed QSM was used to calculate the cerebral SvO2 of each region of interest (ROI) in the ischemic hemisphere. The intraclass correlation coefficient (ICC) and Bland−Altman analysis were conducted to define the best resolution of the distribution map. The correlation between the cerebral SvO2 in hypoxic regions (SvO2ROI < 0.7) and clinical scores was obtained by Spearman and power analysis. The associations between cerebral SvO2 and unfavorable prognosis were analyzed using multivariate logistic regression. Excellent agreement was found between the cerebral SvO2 in hypoxic regions with a resolution of 7.18 × 7.18 × 1.6 mm3 and asymmetrically prominent cortical veins regions (ICC: 0.879 (admission), ICC: 0.906 (discharge)). The cerebral SvO2 was significantly negative with clinical scores (all |r| > 0.3). The cerebral SvO2 and its changes at discharge were significantly associated with an unfavorable prognosis (OR: 0.812 and 0.866). Therefore, the cerebral SvO2 in hypoxic regions measured by the quantitative distribution map can be used as an indicator for evaluating the early prognosis of AIS.
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Affiliation(s)
- Fengqiu Cao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
| | - Mingming Wang
- Department of Radiology, School of Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai 200434, China
| | - Shanhua Han
- Department of Radiology, School of Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai 200434, China
| | - Shengyu Fan
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
| | - Yingwei Guo
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
| | - Yingjian Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
| | - Yu Luo
- Department of Radiology, School of Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai 200434, China
- Correspondence: (Y.L.); (J.G.); (Y.K.); Tel.: +86-13-9404-72926 (Y.K.)
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, NY 10027, USA
- Correspondence: (Y.L.); (J.G.); (Y.K.); Tel.: +86-13-9404-72926 (Y.K.)
| | - Yan Kang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518118, China
- Engineering Research Centre of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang 110169, China
- School of Applied Technology, Shenzhen University, Shenzhen 518060, China
- Correspondence: (Y.L.); (J.G.); (Y.K.); Tel.: +86-13-9404-72926 (Y.K.)
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Association between Deep Medullary Veins in the Unaffected Hemisphere and Functional Outcome in Acute Cardioembolic Stroke: An Observational Retrospective Study. Brain Sci 2022; 12:brainsci12080978. [PMID: 35892419 PMCID: PMC9330894 DOI: 10.3390/brainsci12080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: To explore whether deep medullary veins (DMVs) in the unaffected hemisphere were associated with functional outcome in acute cardioembolic stroke patients. Methods: Acute cardioembolic stroke patients at a single center were retrospectively included. DMVs visibility in the unaffected hemisphere was assessed using a well-established four-grade scoring method based on susceptibility-weighted imaging (SWI): grades 0−3 (grade 0 for no visible DMVs; grade 1 for the numbers of conspicuous DMVs < 5; grade 2 for numbers raging from 5 to 10; grade 3 for more than 10). Patients were further divided into mild-to-moderate (grade 0−2) and severe DMVs (grade 3) groups. Functional outcomes were evaluated using the modified Rankin scale (mRS) score at three months. Poor outcome was defined as mRS ≥ 3. Binary logistic regression analysis was used to explore the association between DMVs grade and functional outcome. Results: A total of 170 patients were finally included. Compared with the mild-to-moderate DMVs group (149 patients), the severe DMVs group (21 patients) had higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.002), lower levels of admission systolic blood pressure (BP) (p = 0.031), and elevated rates of large infarction (p = 0.003). At three months, the severe DMVs group had higher mRS (p = 0.002). Patients in the poor outcome group (82/170, 48.2%) had older age, higher baseline NIHSS score, lower admission diastolic BP, higher rates of hemorrhagic transformation and large infarction, and an increased proportion of severe DMVs (all p < 0.05). After adjusting for confounders, multivariable regression analysis showed that the severe DMVs grade (adjusted odds ratio [OR] = 5.830, 95% confidence interval [CI] = 1.266−26.856, p = 0.024) was significantly associated with three-month functional outcomes without interaction with other potential risk factors (p for interaction > 0.05). Conclusions: DMVs grade in the unaffected hemisphere was independently associated with three-month functional outcome in acute cardioembolic stroke patients. Patients with severe DMVs were more likely to have a poor functional outcome at three months.
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Del Poggio A, Godi C, Calloni SF, Ragusi M, Iadanza A, Falini A, Anzalone N. Multiple hypointense veins on susceptibility weighted imaging as a promising biomarker of impaired cerebral hemodynamics in chronic steno-occlusive disease: a multiparametric MRI study. Neuroradiology 2022; 64:2235-2243. [PMID: 35699773 DOI: 10.1007/s00234-022-02994-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with steno-occlusive arterial disease may develop cerebral hypoperfusion with possible neurologic sequelae. The aim of the study is to verify the possible role of SWI, as a marker of cerebral hypoperfusion, in the identification of patient subgroups with significant chronic occlusions/stenoses at risk of critical cerebral hypoperfusion. METHODS We retrospectively identified 37 asymptomatic patients with chronic intra-extracranial occlusion/stenosis of the anterior circulation from a prospective brain MRI register between 2016 and 2020. All patients underwent 3 Tesla MRI. The imaging protocol included the following: SWI, 3D-FLAIR, DWI sequences, and 3D-TOF MRA. SWI findings were graded for the presence of asymmetric intracranial cortical veins (grades 1 to 4). The presence of collateralization was assessed with concomitant multiphase-CTA. FLAIR was evaluated for the presence of distal hyperintense vessels (DHVs), a described marker of flow impairment, and possible collateralization. Cerebral blood flow and arterial transit artifacts (ATAs) were evaluated at pCASL in 29 patients. RESULTS SWI showed multiple hypointense vessels (MHVs) in 22/37 patients in the cerebral hemisphere ipsilateral to vessel occlusion/stenosis. SWI-MHV grade 1 was found in 15 patients (40.5%), grade 2 in 18 patients (48.7%), and grade 3 in 3 patients (8.1%); in one patient, SWI was graded as 4 (2.7%). A significant relationship was found among MHV, DHV, collaterals, ATAs, and hypoperfused areas on pCASL and with patients' previous neurological symptoms. CONCLUSION SWI-MVH correlates with chronic cerebral flow impairment and is related to hypoperfusion and collateralization. It may help identify a subgroup of patients benefitting from revascularization.
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Affiliation(s)
- Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
| | - Claudia Godi
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Sonia Francesca Calloni
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Maria Ragusi
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Antonella Iadanza
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.,San Raffaele Vita-Salute University, Milan, Italy
| | - Nicoletta Anzalone
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.,San Raffaele Vita-Salute University, Milan, Italy
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8
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Hirtz C, Adam G, Raposo N, Fabre N, Ducros A, Calviere L, Rousseau V, Albucher JF, Olivot JM, Bonneville F, Viguier A. Diagnostic utility of T2*-weighted GRE in migraine with aura attack. The cortical veins sign. Cephalalgia 2022; 42:730-738. [PMID: 35301873 DOI: 10.1177/03331024221076484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the frequency, distribution, and clinical associations of the dilated appearance of cerebral cortical veins, termed cortical veins sign on T2*-weighted gradient recalled-echo (T2*-GRE) in the acute setting of migraine with aura attack in adult patients. METHODS We conducted a retrospective analysis of 60 consecutive patients admitted for acute neurological symptoms with a final diagnosis of migraine with aura (42%) or probable migraine with aura (58%) who underwent emergency brain magnetic resonance imaging and 60 non-migrainous control adults. The cortical veins sign was defined as a marked hypo-intensity and/or an apparent increased diameter of at least one cortical vein. We examined the prevalence, the spatial distribution, and the associations of cortical veins sign with clinical characteristics of migraine with aura. RESULTS We detected the cortical veins sign in 25 patients (42%) with migraine with aura, compared to none in the control group (p < 0.0001). The spatial distribution of cortical veins sign was characterised by the predominantly bilateral and posterior location. Presence of cortical veins sign was associated with increased severity of aura (p = 0.05), and shorter delay to MRI (p = 0.02). CONCLUSION In the setting of acute neurological symptoms, the presence of cortical veins sign is frequent in patients with migraine with aura and can be detected with good reliability. This imaging marker may help clinicians identify underlying migraine with aura.
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Affiliation(s)
- Chloe Hirtz
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Gilles Adam
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Nelly Fabre
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Lionel Calviere
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Vanessa Rousseau
- Department of Pharmacovigilence and Pharmaco-epidemiology, Toulouse University, Toulouse, France
| | - Jean François Albucher
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Jean-Marc Olivot
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Alain Viguier
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
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9
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The Frequency and Associated Factors of Asymmetrical Prominent Veins: A Predictor of Unfavorable Outcomes in Patients with Acute Ischemic Stroke. Neural Plast 2021; 2021:9733926. [PMID: 34567108 PMCID: PMC8463180 DOI: 10.1155/2021/9733926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The present study is aimed at investigating the frequency and associated factors of asymmetrical prominent veins (APV) in patients with acute ischemic stroke (AIS). Methods Consecutive patients with AIS admitted to the Comprehensive Stroke Center of Shanghai Fourth People's Hospital between January 2013 and December 2017 were enrolled. MRI including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and susceptibility-weighted imaging (SWI) was performed within 12 hours of symptom onset. The volume of asymmetrical prominent veins (APV) was evaluated using the Signal Processing In nuclear magnetic resonance software (SPIN, Detroit, Michigan, USA). Multivariate analysis was used to assess relationships between APV findings and medical history, clinical variables as well as cardio-metabolic indices. Results Seventy-six patients met the inclusion criteria. The frequency of APV ≥ 10 mL was 46.05% (35/76). Multivariate analyses showed that proximal artery stenosis or occlusion (≥50%) (P < 0.001, adjusted odds ratio (OR) = 660.0, 95%CI = 57.28-7604.88) and history of atrial fibrillation (P < 0.001, adjusted OR = 10.48, 95%CI = 1.78-61.68) were independent factors associated with high APV (≥10 mL). Conclusion Our findings suggest that the frequency of APV ≥ 10 mL is high in patients with AIS within 12 hours of symptom onset. History of atrial fibrillation and severe proximal artery stenosis or occlusion are strong predictors of high APV as calculated by SPIN on the SWI map.
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10
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Jiang H, Zhang Y, Pang J, Shi C, Liu AF, Li C, Jin M, Man F, Jiang WJ. Susceptibility-diffusion mismatch correlated with leptomeningeal collateralization in large vessel occlusion stroke. J Int Med Res 2021; 49:3000605211013179. [PMID: 34038211 PMCID: PMC8161861 DOI: 10.1177/03000605211013179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the relationship between asymmetric prominent hypointense vessels (prominent vessel sign, PVS) on susceptibility-weighted imaging (SWI) and leptomeningeal collateralization in patients with acute ischemic stroke due to large vessel occlusion. Methods We retrospectively enrolled patients with M1 segment occlusion of the middle cerebral artery who underwent emergency magnetic resonance imaging and digital subtraction angiography within 24 hours from stroke onset. The extent of PVS on SWI was assessed using the Alberta Stroke Program Early CT Score (ASPECTS). Leptomeningeal collateralization on digital subtraction angiography images was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Spearman’s rank correlation test was performed to explore the correlation of ASITN/SIR scores with SWI-ASPECTS and SWI-diffusion-weighted imaging (DWI) mismatch scores. Results Thirty-five patients were enrolled. There was no significant correlation between SWI-ASPECTS and ASITN/SIR scores. However, SWI-DWI mismatch scores were positively correlated with ASITN/SIR scores. Conclusion The range of PVS on SWI did not closely reflect the collateral status, while the range of SWI-DWI mismatch was significantly correlated with the leptomeningeal collateralization. In patients with acute anterior circulation stroke due to large vessel occlusion, larger SWI-DWI mismatch was associated with better leptomeningeal collaterals.
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Affiliation(s)
- Haifei Jiang
- Medical College of Soochow University, Suzhou, China.,Stroke Center, Tongzhou People's Hospital, Nantong, China
| | - Yiqun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jiangxia Pang
- Medical College of Soochow University, Suzhou, China
| | - Chaojie Shi
- Stroke Center, Tongzhou People's Hospital, Nantong, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Fengyuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, China.,New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
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11
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Kim YW, Choi YY, Park SY, Kim HJ, Kim YS. Prominent hypointense vessel on susceptibility-weighted images accompanying hyperacute and acute large infarction. Jpn J Radiol 2021; 39:681-689. [PMID: 33743148 DOI: 10.1007/s11604-021-01107-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple prominent hypointense vessels on susceptibility-weighted image (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. SWI is suitable for venous imaging. PURPOSE To evaluate the conditions of prominent hypointense vessel (PHV) in hyperacute and acute cerebral infarctions using susceptibility-weighted image (SWI). MATERIALS AND METHODS Magnetic resonance images, including SWI, of 284 patients with acute infarction were evaluated. Based on lesion size, the infarction was classified as a small (< 3 cm) or a large (> 3 cm) infarction. Stage of infarction was classified as hyperacute (< 6 h) or acute (> 6 h, < 1 week) on the basis of the onset of stroke. The site of infarction was categorised as a deep grey matter or a mixed (cortical and/or deep grey matter) infarction. The venous structures were analysed qualitatively for the calibre difference between ipsilateral and contralateral hemispheres. We quantitatively analysed the relationship between the size of areas with PHV on SWI and the abnormalities on MR angiography, apparent diffusion coefficient value, and signal intensity on T2WI in the 271 patients. RESULTS PHV over the infarction site was observed in 54.1% (137/253) of the large infarctions, and 19.3% (6/31) of the small infarctions on SWI. PHV was demonstrated in 63.1% (118/187) of mixed infarctions and 25.8% (25/97) of deep grey matter infarctions, and 59.2% (58/98) in hyperacute and 45.7% (85/186) of acute infarctions. The presence of PHV was statistically significant in the size and region of cerebral infarction (p < 0.05), and was not significant in the stage of infarction (p = 0.137). Quantitative analysis revealed significant differences in the MRA abnormalities and ADC values in the PHV ( +) group (p < 0.05) and no significant difference in the T2WI SI ratio in the PHV ( +) group (p = 0.086), compared with PHV (-) group. CONCLUSION PHV on SWI was more prominent at the portions with the large and mixed infarctions. PHV was observed both in hyperacute and acute infarction.
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Affiliation(s)
- Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yoon Young Choi
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Shin Young Park
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Hak Jin Kim
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, South Korea.
| | - Yong Sun Kim
- Department of Radiology, College of Medicine, Kyungpook National University, Daeku, South Korea
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Jiang HF, Zhang YQ, Pang JX, Shao PN, Qiu HC, Liu AF, Li C, Jin M, Man FY, Jiang WJ. Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke. Sci Rep 2021; 11:5641. [PMID: 33707446 PMCID: PMC7952411 DOI: 10.1038/s41598-021-84269-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.
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Affiliation(s)
- Hai-Fei Jiang
- Medical College of Soochow University, Suzhou, 215123, China.,Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Yi-Qun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Jiang-Xia Pang
- Medical College of Soochow University, Suzhou, 215123, China
| | - Pei-Ning Shao
- Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Han-Cheng Qiu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Feng-Yuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, 215123, China. .,New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China.
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13
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Liu Y, Dong J, Song Q, Zhang N, Wang W, Gao B, Tian S, Dong C, Liang Z, Xie L, Miao Y. Correlation Between Cerebral Venous Oxygen Level and Cognitive Status in Patients With Alzheimer's Disease Using Quantitative Susceptibility Mapping. Front Neurosci 2021; 14:570848. [PMID: 33536866 PMCID: PMC7848136 DOI: 10.3389/fnins.2020.570848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To quantitatively assess the blood oxygen levels of the cerebral vein using quantitative susceptibility mapping (QSM), and to analyze the correlation between magnetic susceptibility value (MSV) and clinical laboratory indicators/cognitive scores in patients with Alzheimer's disease (AD). Materials and Methods Fifty-nine patients (21 males and 38 females) with clinically confirmed AD (AD group) and 22 control subjects (12 males, 10 females; CON group) were recruited. Clinical data and laboratory examination indexes were collected. All patients underwent Mini-mental State Examination, Montreal Cognitive Assessment, Clock Drawing Task, and Activity of Daily Living Scale test, as well as a routine MRI and enhanced gradient echo T2 star weighted angiography (ESWAN). Results Higher cerebral venous MSV was observed in AD group compared to CON group, significant differences were observed for bilateral thalamus veins and left dentate nucleus veins. The MSV of bilateral thalamus veins, bilateral internal cerebral veins, and bilateral dentate nucleus veins had significant negative correlation with Mini-mental State Examination score; the MSV of bilateral thalamus veins, bilateral dentate nucleus veins, right septal vein had a significant negative correlation with Montreal Cognitive Assessment scores; a significant negative correlation between the MSV of bilateral thalamus veins, left dentate nucleus vein, right septal vein and the Clock Drawing Task score; the MSV of bilateral thalamus veins, left dentate nucleus vein had a significant negative correlation with Activity of Daily Living Scale score. The MSV of left dentate nucleus vein was positively correlated with the course of the disease, the MSV of bilateral septal vein were positively correlated with the total cholesterol, and the MSV of left septal vein had a positive correlation with LDL. Conclusion Decreasing cerebral venous oxygen level in AD patients may affect cognitive status, and associated with the deterioration of the disease in AD patients.
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Affiliation(s)
- YangYingQiu Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - JunYi Dong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - QingWei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - WeiWei Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - BingBing Gao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - ShiYun Tian
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - ChunBo Dong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - ZhanHua Liang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - LiZhi Xie
- GE Healthcare, MR Research China, Beijing, China
| | - YanWei Miao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Jiang H, Zhang Y, Pang J, Qiu HC, Liu AF, Li C, Zhou J, Jin M, Man F, Jiang WJ. Interactive effect of susceptibility-diffusion mismatch and recanalization status on clinical outcome in large vessel occlusion stroke. J Stroke Cerebrovasc Dis 2020; 29:105072. [PMID: 32807474 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the interactive effect of susceptibility-diffusion mismatch and recanalization status on clinical outcome in patients with acute ischemic stroke due to large vessel occlusion. METHODS In this prospective study, consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission, including diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and time-of-flight magnetic resonance angiography (TOF-MRA). Patients with large vessel occlusion within the anterior circulation were recruited. Follow-up MRI was performed within 24 h after recanalization therapy (intravenous thrombolysis, endovascular therapy, or both). Multivariable logistic regression analysis was performed to estimate the interaction between SWI-DWI mismatch score and recanalization status on clinical outcome. RESULTS A total of 90 patients were enrolled. A multiplicative interaction between SWI-DWI mismatch score and recanalization status on clinical outcome was observed (P=0.037). The interaction term "SWI-DWI mismatch score × successful recanalization" was significantly associated with favorable outcome (modified Rankin Scale score of 0-2 at 90 days; adjusted odds ratio [aOR], 2.162; 95% confidence interval [CI], 1.046-4.468). Stratified analysis showed that the likelihood of favorable outcome increased with the increase of SWI-DWI mismatch score in the successful recanalization group (OR, 2.140; 95% CI, 1.376-3.326), while there was no significant relationship between SWI-DWI mismatch score and clinical outcome in the unsuccessful recanalization group (OR, 1.212; 95% CI, 0.933-1.574). CONCLUSIONS The effects of SWI-DWI mismatch and recanalization status on clinical outcome were realized through their interaction. In anterior circulation stroke due to large vessel occlusion, patients with both high SWI-DWI mismatch scores and successful recanalization were more likely to achieve a favorable outcome, while patients with unsuccessful recanalization, or with successful recanalization but low SWI-DWI mismatch scores, were less likely to have a good prognosis.
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Affiliation(s)
- Haifei Jiang
- Medical College of Soochow University, Suzhou, China; Department of Neurology, Tongzhou People's Hospital, Nantong, China.
| | - Yiqun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Jiangxia Pang
- Medical College of Soochow University, Suzhou, China.
| | - Han-Cheng Qiu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Ji Zhou
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Fengyuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, China; New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street No 16, Beijing, China.
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Liu YL, Xiao WM, Lu JK, Wang YZ, Lu ZH, Zhong HH, Qu JF, Fang XW, Liang MQ, Chen YK. Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke. Brain Behav 2020; 10:e01657. [PMID: 32436291 PMCID: PMC7375089 DOI: 10.1002/brb3.1657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) could predict 90-day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r-tPA). METHODS Clinical data of consecutive patients with anterior circulation AIS treated with r-tPA were retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, NIHSS score, onset to treatment time, and initial hematologic and neuroimaging findings. Follow-up was performed 90 days after onset. Poor outcome was defined as a modified Rankin scale (mRS) ≥3 at 90 days. RESULTS A total of 145 patients were included, 35 (24.1%) patients presented with ACVS (≥Grade 1) on SWI. Fifty-three (36.6%) patients had a poor outcome at 90 days. ACVS (≥Grade 1) occurred in 21 (39.6%) patients with poor outcome compared with 14 (15.2%) patients with favorable outcome (p = .001). Univariate analysis indicated that age, NIHSS score on admission, previous stroke, hemorrhagic transformation, severe intracranial large artery stenosis or occlusion (SILASO), and ACVS were associated with 90-day poor outcome (p < .05). Since SILASO and ACVS were highly correlated and ACVS had different grades, we used three logistic regression models. Results from the three models showed that ACVS was associated with 90-day poor outcome. CONCLUSIONS In r-tPA-treated patients with anterior circulation AIS, ACVS might be a helpful neuroimaging predictor for poor outcome at 90 days.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Jie-Kai Lu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Ya-Zhi Wang
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Zhi-Hao Lu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Xue-Wen Fang
- Department of Radiology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Man-Qiu Liang
- Department of Radiology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
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Liu YL, Yin HP, Qiu DH, Qu JF, Zhong HH, Lu ZH, Wang F, Liang MQ, Chen YK. Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis. Stroke Vasc Neurol 2020; 5:361-367. [PMID: 32586972 PMCID: PMC7804053 DOI: 10.1136/svn-2020-000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
Background and purpose Early neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA). Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. We collected clinical variables and initial haematological and neuroimaging findings. MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere. The degree of hyperintensity of MHVs was classified into four grades: none, subtle, moderate and extensive. END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms. Multivariate logistic regressions were conducted to investigate the predictors of END. Results The study included 61 patients (51 males and 10 females) with a mean age of 62.4±12.6 years. Thirty-five (57.4%) patients presented with MHVs: 8 (13.1%) were graded as subtle MHVs, while 23 (37.7%) and 4 (6.6%) were graded as moderate or extensive MHVs, respectively. Twenty patients (32.8%) presented with END. Logistic regression analysis showed that compared with patients without MHVs, moderate MHVs (adjusted OR 5.446, 95% CI 1.360 to 21.800; p=0.017) and extensive MHVs (adjusted OR 15.240, 95% CI 1.200 to 193.544; p=0.036) were significantly associated with END. Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Han-Peng Yin
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Zhi-Hao Lu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Fang Wang
- Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Man-Qiu Liang
- Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
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Nan D, Cheng Y, Feng L, Zhao M, Ma D, Feng J. Potential Mechanism of Venous System for Leukoaraiosis: From post-mortem to in vivo Research. NEURODEGENER DIS 2020; 19:101-108. [PMID: 32045917 DOI: 10.1159/000505157] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leukoaraiosis (LA), widely accepted as a feature of cerebral small vessel disease, significantly increases the incidence of stroke, dementia, and death. Cerebral small artery disease has been considered as one of the main causes of LA. However, since the term "venous collagenosis" (VC) was proposed in an atrophy research in 1995, there have been pathological and neuroimaging studies proving the association between the venous system and LA in aging, Alz-heimer's disease (AD), and Parkinson's disease. SUMMARY Autopsy studies confirmed that thickening of the lumen wall in venules, which results from the deposition of collagen I and III, leading to vessel stenosis or occlusion, is closely associated with LA. Susceptibility-weighted imaging research revealed a controversial association of deep medullary veins and LA in vivo, regarding which there are no standard criteria currently. Nevertheless, retinal venous changes had been reported to increase the risk of LA development, providing a novel way for in vivo evaluation. As for the internal jugular vein, jugular venous reflux could double the LA score in aging and modulate circulation of cerebral spinal fluids. Key Messages: Disruption of the venous system was notably associated with LA in aging, AD, and Parkinson's disease post-mortem and in in vivo models. The venous pathological changes may induce cerebral hypoperfusion, drainage system disruption, and vasogenic oedema in the veins around the periventricular white matter. The clarification of VC in LA may provide an early prevention and early treatment strategy for LA patients.
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Affiliation(s)
- Di Nan
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yingying Cheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Liangshu Feng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Mingming Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Di Ma
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jiachun Feng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China,
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Darwish EAF, Abdelhameed-El-Nouby M, Geneidy E. Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging. Insights Imaging 2020; 11:6. [PMID: 31930428 PMCID: PMC6955386 DOI: 10.1186/s13244-019-0810-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patients Methods Twenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS). Results IG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ2 = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (rs = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (rs = 0.788, p = 0.000) Conclusion A positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
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Affiliation(s)
- Eman A F Darwish
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt.
| | | | - Eman Geneidy
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt
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Ling C, Zhang Z, Wu Y, Fang X, Kong Q, Zhang W, Wang Z, Yang Q, Yuan Y. Reduced Venous Oxygen Saturation Associates With Increased Dependence of Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: A 7.0-T Magnetic Resonance Imaging Study. Stroke 2019; 50:3128-3134. [PMID: 31514698 DOI: 10.1161/strokeaha.119.026376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Accumulating evidence has demonstrated hemodynamic abnormalities and cerebral hypoperfusion in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Increased venous susceptibility assessed by susceptibility weighted imaging and mapping has been shown to indicate a decrease in venous oxygen saturation. This study aimed to investigate whether altered venous oxygen saturation is related to clinical phenotypes of CADASIL patients. Methods- Using 7.0-T susceptibility weighted imaging and mapping, we compared venous susceptibility of cortical veins between 41 CADASIL patients and 43 age- and sex-matched healthy controls. The magnetic resonance imaging lesion load, mini-mental state examination score, Barthel Index, and modified Rankin Scale were examined in the patient group, and the correlations between venous susceptibility and clinical characteristics were analyzed. Results- Venous susceptibility increased with age (r=0.508, P=0.001) and was higher in CADASIL patients than in healthy controls (t=-4.673; P<0.001). We found a positive association between venous susceptibility and the age-related white matter change scores (r=0.364; P=0.019), number of lacunar infarctions (r=0.520; P<0.001), number of cerebral microbleeds (ρ=0.445; P=0.004), and small-vessel disease scores (ρ=0.465; P=0.002) in CADASIL patients. Moreover, increased venous susceptibility was associated with higher modified Rankin Scale scores in CADASIL patients after adjustment for age- and small-vessel disease scores (odds ratio=3.178; 95% CI, 1.101-9.179; P=0.033). Conclusions- Our findings indicate that extensive cerebral hypoperfusion may induce central nervous system impairment in CADASIL, and susceptibility weighted imaging and mapping could be used clinically to assess the condition of CADASIL patients.
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Affiliation(s)
- Chen Ling
- From the Department of Neurology, Peking University First Hospital, Beijing, China (C.L., X.F., W.Z., Z.W., Y.Y.)
| | - Zihao Zhang
- From the Department of Neurology, Peking University First Hospital, Beijing, China (C.L., X.F., W.Z., Z.W., Y.Y.)
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
- CAS Center for Excellence in Brain Science and Intelligence Technology, Beijing, China (Z.Z., Y.W., Q.K.)
- University of Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
| | - Yue Wu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
- CAS Center for Excellence in Brain Science and Intelligence Technology, Beijing, China (Z.Z., Y.W., Q.K.)
- University of Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
| | - Xiaojing Fang
- Department of Neurology, Peking University International Hospital, Beijing, China (X.F.)
| | - Qingle Kong
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
- CAS Center for Excellence in Brain Science and Intelligence Technology, Beijing, China (Z.Z., Y.W., Q.K.)
- University of Chinese Academy of Sciences, Beijing, China (Z.Z., Y.W., Q.K.)
| | - Wei Zhang
- From the Department of Neurology, Peking University First Hospital, Beijing, China (C.L., X.F., W.Z., Z.W., Y.Y.)
| | - Zhaoxia Wang
- From the Department of Neurology, Peking University First Hospital, Beijing, China (C.L., X.F., W.Z., Z.W., Y.Y.)
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China (Q.Y.)
| | - Yun Yuan
- From the Department of Neurology, Peking University First Hospital, Beijing, China (C.L., X.F., W.Z., Z.W., Y.Y.)
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20
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Park MS, Kwon S, Lee MJ, Kim KH, Jeon P, Park YJ, Kim DI, Kim YW, Bang OY, Chung CS, Lee KH, Kim GM. Identification of High Risk Carotid Artery Stenosis: A Multimodal Vascular and Perfusion Imaging Study. Front Neurol 2019; 10:765. [PMID: 31379719 PMCID: PMC6647800 DOI: 10.3389/fneur.2019.00765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Risk stratification of asymptomatic carotid artery stenosis (ACAS) is still an issue for carotid revascularization. We sought to identify factors associated with symptomatic carotid artery stenosis (SCAS) using multimodal imaging techniques. Methods: We retrospectively collected data on patients who underwent carotid artery revascularization. Results from duplex sonography, computerized tomography angiography, brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), perfusion-weighted imaging, and demographic profiles were compared between ACAS and SCAS patients. Differences in baseline characteristics between the two groups were balanced by the propensity matching score method. Multivariable regression analysis was performed to identify factors associated with symptomaticity of carotid artery stenosis. We compared the strength of associations between significant imaging factors and symptomatic carotid stenosis using C statistics. Results: A total of 259 patients (asymptomatic 57.1%, symptomatic 42.9%) with carotid stenosis were included. After 1:1 propensity score matching, the multivariable regression analysis revealed that the absence of plaque calcification [Odds ratio 0.41, 95% confidence interval (CI) 0.182–0.870, p = 0.023], deep white matter hyperintensity (DWMH; Odds ratio 3.46, 95% CI 1.842–6.682, p < 0.001), susceptibility vessel sign seen on gradient-echo MRI (Odds ratio 2.35, 95% CI 1.113–5.107, p = 0.027), and increased cerebral blood volume (CBV) seen on perfusion-weighted MRI (CBV; Odds ratio 2.17, 95% CI 1.075–4.454, p = 0.032) were associated with SCAS. The combination of these variables had a fair accuracy to classify SCAS (Area under the curve 0.733, 95% CI 0.662–0.803). Conclusions: We identified several multimodal imaging markers independently associated with SCAS. These markers may provide information to identify ACAS patients with high risk of ischemic stroke. Future studies are needed to predict SCAS using our findings in other independent cohorts.
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Affiliation(s)
- Moo-Seok Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soonwook Kwon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keon Ha Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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21
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Kim P, Langheinrich K, Cristiano B, Grigsby P, Oyoyo U, Kido D, Paul Jacobson J. Low thalamostriate venous quantitative susceptibility measurements correlate with higher presenting NIH stroke scale score in emergent large vessel occlusion stroke. J Int Med Res 2019; 48:300060519832462. [PMID: 30859887 PMCID: PMC7140206 DOI: 10.1177/0300060519832462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Hyperacute stroke affects various patient subgroups who may benefit from
different management strategies. Magnetic resonance imaging (MRI)
quantitative susceptibility mapping (QSM) is a recent MRI technique for
measuring deoxyhemoglobin levels. The results of QSM thus have the potential
to act as a quantitative biomarker for predicting the success of
endovascular interventions. Methods Twenty-five patients with M1 occlusions were evaluated retrospectively. QSM
measurements were obtained based on susceptibility-weighted imaging
sequences from the most prominent veins in each of the four standard regions
of interest: the cortical and thalamostriate veins ipsilateral and
contralateral to the side of the stroke. The results were analyzed using
Wilcoxon’s signed rank test and compared with presenting National Institutes
of Health stroke scale (NIHSS) score. Results Cortical veins ipsilateral to the stroke showed the greatest elevation in
susceptibility compared with all other vein groups. Both ipsilateral and
contralateral thalamostriate vein susceptibilities showed strong inverse
correlation with presenting NIHSS score. Conclusion Thalamostriate vein susceptibility shows a strong inverse correlation with
presenting NIHSS in adult patients with hyperacute stroke who are selected
for endovascular intervention by advanced imaging.
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Affiliation(s)
- Paggie Kim
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Brian Cristiano
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Phillip Grigsby
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Udo Oyoyo
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Daniel Kido
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - J Paul Jacobson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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22
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Halefoglu AM, Yousem DM. Susceptibility weighted imaging: Clinical applications and future directions. World J Radiol 2018; 10:30-45. [PMID: 29849962 PMCID: PMC5971274 DOI: 10.4329/wjr.v10.i4.30] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
Abstract
Susceptibility weighted imaging (SWI) is a recently developed magnetic resonance imaging (MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the magnetic susceptibility differences of various compounds including deoxygenated blood, blood products, iron and calcium, thus enabling a new source of contrast in MR. In this review, we illustrate its basic clinical applications in neuroimaging. SWI is based on a fully velocity-compensated, high-resolution, three dimensional gradient-echo sequence using magnitude and phase images either separately or in combination with each other, in order to characterize brain tissue. SWI is particularly useful in the setting of trauma and acute neurologic presentations suggestive of stroke, but can also characterize occult low-flow vascular malformations, cerebral microbleeds, intracranial calcifications, neurodegenerative diseases and brain tumors. Furthermore, advanced MRI post-processing technique with quantitative susceptibility mapping, enables detailed anatomical differentiation based on quantification of brain iron from SWI raw data.
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Affiliation(s)
- Ahmet Mesrur Halefoglu
- Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34371, Turkey
| | - David Mark Yousem
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Institution, Baltimore, MI 21287, United States
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23
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Taoka T, Fukusumi A, Miyasaka T, Kawai H, Nakane T, Kichikawa K, Naganawa S. Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders. Radiographics 2017; 37:281-297. [PMID: 28076020 DOI: 10.1148/rg.2017160061] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. ©RSNA, 2017.
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Affiliation(s)
- Toshiaki Taoka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Akio Fukusumi
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiteru Miyasaka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Hisashi Kawai
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiki Nakane
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Kimihiko Kichikawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Shinji Naganawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
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24
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Payabvash S, Taleb S, Benson JC, Hoffman B, Oswood MC, McKinney AM, Rykken JB. Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications. Acta Radiol 2017; 58:876-882. [PMID: 27799573 DOI: 10.1177/0284185116675658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.
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Affiliation(s)
| | - Shayandokht Taleb
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - John C Benson
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Evaluation of the role of susceptibility-weighted imaging in thrombolytic therapy for acute ischemic stroke. J Clin Neurosci 2017; 40:175-179. [PMID: 28228323 DOI: 10.1016/j.jocn.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/22/2017] [Indexed: 11/20/2022]
Abstract
We inspected low-intensity venous signals and microbleeds in patients with acute ischemic stroke (AIS) using susceptibility-weighted imaging (SWI) before and after administration of within-thrombolytic-time-window thrombolytic therapies, and observed their prognosis and safety, in order to guide individualized thrombolytic therapies. Patients with AIS were divided into groups A or B according to the presence of symmetric or asymmetric veins on SWI, and were re-inspected by SWI after intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA). The National Institutes of Health stroke scale (NIHSS) score before treatment and at 1-h and 24-h posttreatment in the two groups were 11.9, 7.3, and 7.1 in group A, 12.4, 8.2, and 7.9 in group B, significant difference was detected between the two groups after treatment. The 90-day mortality rate was 0, and the incidences of cerebral microbleeds (CMBs) and symptomatic cerebral hemorrhage (SCH) were 17.6%, and 0% in group A, 25.6% and 0% in group B, respectively. The incidences of CMBs and SCH in group A were lower than those in group B, but the intergroup differences were not statistically significant (P>0.05). The 90-day neurological improvement rates in the two groups were 70.2% and 58.1%, respectively, and group A showed a significantly better prognosis than group B (P<0.05). Thus, low-intensity venous signals in SWI can be used to evaluate a low level of perfusion, post-thrombolytic prognosis, and bleeding indexes, and can therefore be used to guide individualized thrombolytic therapies.
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Wu X, Luo S, Wang Y, Chen Y, Liu J, Bai J, Feng J, Zhang H. Use of susceptibility-weighted imaging in assessing ischemic penumbra: A case report. Medicine (Baltimore) 2017; 96:e6091. [PMID: 28178170 PMCID: PMC5313027 DOI: 10.1097/md.0000000000006091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE The ischemic penumbra assessment is essential for the subsequent therapy and prediction of evolution in patients with acute ischemic infraction. Although controversial as a perfect equivalence to penumbra, perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance of PWI on contrast agents, noninvasive alternatives remain an unmet need. PATIENT CONCERNS We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital. DIAGNOSIS We diagnosed it as acute ischemic stroke caused by the left middle cerebral artery stenosis. INTERVENTIONS Susceptibility-weighted imaging (SWI), multimodal magnetic resonance imaging (MRI) work-up which includes conventional MRI sequences (T1WI, T2WI, and FLAIR), DWI, PWI. OUTCOMES His DWI-SWI mismatch was comparable to that of DWI-PWI at admission, suggesting that DWI-SWI could predict ischemic penumbra in patient with acute infarction. He refused the digital subtraction angiography examination or stenting, and he was treated with aspirin, atorvastain, and supportive treatment. The patient received a reexamination of the conventional MRI and SWI 11 days later. Expansion of the infarction in the affected MCA territory resulted from the penumbra indicated by the mismatch between DWI-SWI. LESSONS SWI can be used as a noninvasive alternative to evaluate the ischemic penumbra. Besides, SWI can provide perfusion information comparable to PWI and SWI is sufficient to identify occlusive arteries.
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Affiliation(s)
- Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Song Luo
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Ying Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Yang Chen
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Jun Liu
- Department of Neurosurgery, the Second Hospital of Jilin University, Jilin University, Changchun, China
| | - Jing Bai
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Jiachun Feng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Hongliang Zhang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
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Cheng B, Schröder N, Forkert ND, Ludewig P, Kemmling A, Magnus T, Fiehler J, Gerloff C, Thomalla G. Hypointense Vessels Detected by Susceptibility-Weighted Imaging Identifies Tissue at Risk of Infarction in Anterior Circulation Stroke. J Neuroimaging 2016; 27:414-420. [PMID: 28000975 DOI: 10.1111/jon.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The diagnostic value of susceptibility-weighted magnetic resonance imaging of acute stroke patients has shown potential as a surrogate marker of impaired hemodynamics. We investigate the value of asymmetrical hypointense cerebral vessels (HV) for the identification of vessel status and tissue at risk of infarction (TaR). METHODS Symmetry of HV was visually rated on SWI data from a well-defined population of acute anterior circulation stroke with onset <24 hours. MRI perfusion data was analyzed and volumes of tissue at risk segmented using a delay threshold of Tmax> 6 seconds. Status of the extra- and intracranial arteries was assessed by ultrasound and MR angiography. RESULTS 35 patients were included (12 women; median age 69 years, IQR 61-77; median NIHSS at admission 10, IQR 6-20). Asymmetrically distributed HV were detected at the stroke hemisphere in 25 patients (71%). Of those, 12 patients displayed occlusion of the middle cerebral artery, whereas occlusion of the extracranial ICA was detected in 6 patients. TaR was larger, yet not significantly different in patients with asymmetrically HV (mean volume 38.9 ml, SD 52.9 ml) compared to patients showing symmetrical HV (4.2 ml; SD 10.7 ml, p-value 0.081). Significant differences where, however, found after excluding patients with extracranial ICA occlusions (42.9 ml; SD 50.4 ml vs. 4.2 ml, SD 10.8 ml, p-value 0.025). CONCLUSION Visual analysis of HV in SWI identifies tissue at risk in patients with anterior circulation stroke. Potentially pre-existing extracranial ICA occlusions leading to prominent HV have to be considered as a confounding factor.
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Affiliation(s)
- Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N4N1, Canada
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mashhood A, Kim P, Almaguel F, McWilliams G, Jacobson JP. Cerebral Misery Perfusion on Susceptibility Weighted Imaging in Acute Carotid Dissection. J Radiol Case Rep 2016; 10:1-6. [PMID: 28580051 PMCID: PMC5443581 DOI: 10.3941/jrcr.v10i10.2653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The cerebral vasculature incorporates several fail-safes that must be breached before an irreversible ischemic event takes place. In particular, when autoregulatory vasodilatation fails secondary to falling cerebral perfusion pressure (CPP; stage I hemodynamic failure), increases in the oxygen extraction fraction work to maintain the cerebral metabolic rate of oxygen. Previously, failure of this mechanism, stage II hemodynamic failure, or misery perfusion, has been imaged via positron emission tomography/computed tomography (PET/CT). Current susceptibility-weighted sequences (SWI) allow for more efficient imaging of this physiology. In this case, we identify an incident of reversible ischemia caused by spontaneous carotid artery dissection using a combination of diffusion weighted imaging (DWI) and SWI. The level of hemodynamic failure identified by the imaging sequences elevated the urgency of neurointervention, expediting the patient's arrival to the neurointerventional table and thus avoiding impending irreversible ischemia.
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Affiliation(s)
- Arian Mashhood
- Department of Radiology, Loma Linda University Hospital, Loma Linda, USA
| | - Paggie Kim
- Department of Radiology, Loma Linda University Hospital, Loma Linda, USA
| | - Frankis Almaguel
- Department of Radiology, Loma Linda University Hospital, Loma Linda, USA
| | - Geoffery McWilliams
- Department of Radiology, University of California, Davis, Medical Center, Sacramento, USA
| | - J Paul Jacobson
- Department of Radiology, Loma Linda University Hospital, Loma Linda, USA
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Wang C, Qiu T, Song R, Jiaerken Y, Yang L, Wang S, Zhang M, Yu X. A Comparison Study of Single-Echo Susceptibility Weighted Imaging and Combined Multi-Echo Susceptibility Weighted Imaging in Visualizing Asymmetric Medullary Veins in Stroke Patients. PLoS One 2016; 11:e0159251. [PMID: 27494171 PMCID: PMC4975399 DOI: 10.1371/journal.pone.0159251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 06/29/2016] [Indexed: 01/14/2023] Open
Abstract
Background Asymmetric medullary veins (AMV) are frequently observed in stroke patients and single-echo susceptibility weighted imaging (SWIs) is the main technique in detecting AMV. Our study aimed to investigate which echo time (TE) on single-echo susceptibility is the optimal echo for visualizing AMV and to compare the ability in detecting AMV in stroke patients between SWIs and multi-echo susceptibility weighted imaging (SWIc). Materials and Methods Twenty patients with middle cerebral artery stroke were included. SWI was acquired by using a multi-echo gradient-echo sequence with six echoes ranging from 5 ms to 35.240 ms. Three different echoes of SWIs including SWIs1 (TE = 23.144 ms), SWIs2 (TE = 29.192 ms) and SWIs3 (TE = 35.240 ms) were reconstructed. SWIc was averaged using the three echoes of SWIs. Image quality and venous contrast of medullary veins were compared between SWIs and SWIc using peak signal-to-noise ratio (PSNR), mean opinion score (MOS), contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). The presence of AMV was evaluated in each SWIs (1–3) and SWIc. Results SWIs2 had the highest PSNR, MOS and CNR and SWIs1 had the highest SNR among three different echoes of SWIs. No significant difference was found in SNR between SWIs1 and SWIs2. PSNR, MOS and CNR in SWIc were significantly increased by 27.9%, 28.2% and 17.2% compared with SWIs2 and SNR in SWIc was significantly increased by 32.4% compared with SWIs1. 55% of patients with AMV were detected in SWIs2, SWIs3 and SWIc, while 50% AMV were found in SWIs1. Conclusions SWIs using TE around 29ms was optimal in visualizing AMV. SWIc could improve image quality and venous contrast, but was equal to SWIs using a relative long TE in evaluating AMV. These results provide the technique basis for further research of AMV in stroke.
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Affiliation(s)
- Chao Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tiantian Qiu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruirui Song
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yerfan Jiaerken
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linglin Yang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaoze Wang
- Department of Electrical Engineering, Zhejiang University, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- * E-mail:
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Han X, Ouyang L, Zhang C, Ma H, Qin J. Relationship between deep medullary veins in susceptibility-weighted imaging and ipsilateral cerebrovascular reactivity of middle cerebral artery in patients with ischemic stroke. Exp Ther Med 2016; 11:2217-2220. [PMID: 27284303 PMCID: PMC4887931 DOI: 10.3892/etm.2016.3198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/28/2016] [Indexed: 12/01/2022] Open
Abstract
Deep cerebral veins have been recently associated with the severity of hemodynamic impairment in moyamoya disease. The aim of the current study was to determine the correlation of deep medullary veins (DMVs) in susceptibility-weighted imaging (SWI) with ipsilateral cerebrovascular reactivity (CVR) of and anterior cecebrocervical artery stenosis in patients with ischemic stroke. Patients with unilateral TIA or infarction who underwent 3.0 T magnetic resonance imaging SWI, digital subtraction angiography and transcranial Doppler with CO2 stimulation within the first 7 days of hospitalization were retrospectively selected. CVR and stenosis of anterior cerebrocervical arteries were compared between different DMVs stages in symptomatic hemispheres (SHs) and asymptomatic hemispheres (AHs). A total of 61 patients were subsequently included in the present study. A univariate analysis was conducted and results for age (PAHs=0.004, PSHs=0.006), hypertension (PAHs=0.008, PSHs=0.020), current smoking (PAHs=0.006, PSHs=0.021), CVR (PAHs=0.000, PSHs=0.000), and artery stenosis (PAHs=0.000, PSHs=0.000) were obtained. The results suggested statistically significant differences between DMVs grades in SHs and AHs. A subsequent multivariate analysis revealed that CVR (ORAHs=0.925, 95% CIAHs: 0.873–0.981; ORSHs=0.945, 95% CISHs: 0.896–0.996), and artery stenosis (ORAH=3.147, 95% CIAH: 1.010–9.806; ORSHs=2.882, 95% CISHs: 1.017–8.166) were independent risk factors of DMVs. In conclusion, 3.0 T SWI was useful in detecting the DMVs around the lateral ventricle in patients with atherosclerotic ischemic stroke. CVR and stenosis of anterior cerebrocervical arteries were independent risk factors for ipsilateral DMVs in SHs and AHs.
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Affiliation(s)
- Xianjun Han
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Linhui Ouyang
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Chunning Zhang
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Hailing Ma
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Jingcui Qin
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
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Vural A, Gocmen R, Oguz KK, Topcuoglu MA, Arsava EM. Bright and dark vessels on stroke imaging: different sides of the same coin? Diagn Interv Radiol 2016; 22:284-90. [PMID: 27015319 DOI: 10.5152/dir.2015.15271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Prominent hypointense cerebral vessels on susceptibility-weighted imaging (SWI) and the hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) imaging are considered as markers of compromised tissue perfusion in cerebral ischemia. In this study, we aimed to identify the correlation between HVS on FLAIR and hypointense vessels on SWI, and to determine whether these imaging features provide independent prognostic information in patients with ischemic stroke. METHODS We retrospectively analyzed consecutive ischemic stroke patients with proximal middle cerebral artery (MCA) occlusion who underwent SWI and FLAIR within 24 h of symptom onset. The presence of hypointense vessels on SWI and hyperintense vessels on FLAIR in >4 of 10 slices encompassing the MCA territory were considered to represent prominent hypoperfusion. RESULTS Among 50 patients, 62% had a prominent HVS on FLAIR and 68% had prominent hypointense vessels on SWI. There was a moderate but significant correlation between the number of slices with HVS on FLAIR and prominent hypointense vessels on SWI (r=0.425, P = 0.002). In multivariate analyses, the prominence of hypointense vessels on SWI, but not HVS on FLAIR, was significantly associated with a higher discharge NIHSS score (P = 0.027), mRS score (P = 0.021), and lesion growth (P = 0.050). CONCLUSION The significant, albeit moderate, correlation between markers of compromised tissue perfusion on FLAIR and SWI suggests that these imaging features reflect different but interrelated aspects of cerebral hemodynamics during ischemic stroke. Our findings highlight that while HVS on FLAIR denotes the presence of leptomeningeal collaterals, hypointense vessels on SWI signify the sufficiency of cerebral blood flow at the tissue level and are therefore more critical in terms of prognosis.
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Affiliation(s)
- Atay Vural
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey.
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Yu X, Yuan L, Jackson A, Sun J, Huang P, Xu X, Mao Y, Lou M, Jiang Q, Zhang M. Prominence of Medullary Veins on Susceptibility-Weighted Images Provides Prognostic Information in Patients with Subacute Stroke. AJNR Am J Neuroradiol 2016; 37:423-9. [PMID: 26514606 PMCID: PMC7960117 DOI: 10.3174/ajnr.a4541] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/29/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE The demonstration of prominent medullary veins in the deep white matter ipsilateral to acute ischemic stroke has been shown to predict poor clinical outcome. We have investigated the prognostic implications of prominent medullary veins in patients with subacute stroke who present outside the therapeutic window for revascularization therapy. MATERIALS AND METHODS Forty-three consecutive patients with ischemic stroke in the middle cerebral artery territory presenting within 3-7 days of ictus were enrolled. The presence of prominent medullary veins in the periventricular white matter of the ipsilateral and contralateral medullary vein hemispheres was recorded. Perfusion-weighted imaging was used to calculate differences in hemispheric CBF from corresponding areas. Clinical outcome was classified as good if the modified Rankin Scale score was <3. RESULTS Prominent medullary veins were observed in 24/43 patients with 14 ipsilateral medullary veins and 10 contralateral medullary veins. The ipsilateral medullary vein was independently associated with poor outcome (odds ratio, 11.19; P = .046). The contralateral medullary vein was not independently predictive of outcome but was significantly more common in patients with good outcome (90.0% contralateral medullary veins). A mean 64.5% decrease and a 52.4% increase of differences in hemispheric CBF were found in ipsilateral medullary veins and contralateral medullary veins, respectively. CONCLUSIONS The ipsilateral medullary vein was a significant predictive biomarker of poor clinical outcome after stroke and was associated with hypoperfusion. The contralateral medullary vein was associated with good clinical outcome, and we hypothesize that prominent contralateral medullary veins indirectly reflect increased CBF in the ipsilateral hemisphere due to spontaneous recanalization or collateral flow.
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Affiliation(s)
- X Yu
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - L Yuan
- Department of Biomedical Engineering and Instrument Science (L.Y.), Key Laboratory for Biomedical Engineering of Education Ministry of China, Zhejiang University, Hangzhou, China
| | - A Jackson
- Wolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, United Kingdom
| | - J Sun
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - P Huang
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - X Xu
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - Y Mao
- Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - M Lou
- Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Q Jiang
- Department of Neurology (Q.J.), Henry Ford Health System, Detroit, Michigan
| | - M Zhang
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
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Quantitative T2, T2*, and T2' MR imaging in patients with ischemic leukoaraiosis might detect microstructural changes and cortical hypoxia. Neuroradiology 2015; 57:1023-30. [PMID: 26227168 DOI: 10.1007/s00234-015-1565-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/13/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Quantitative MRI with T2, T2*, and T2' mapping has been shown to non-invasively depict microstructural changes (T2) and oxygenation status (T2* and T2') that are invisible on conventional MRI. Therefore, we aimed to assess whether T2 and T2' quantification detects cerebral (micro-)structural damage and chronic hypoxia in lesions and in normal appearing white matter (WM) and gray matter (GM) of patients with ischemic leukoaraiosis (IL). Measurements were complemented by the assessment of the cerebral blood flow (CBF) and the degree of GM and WM atrophy. METHODS Eighteen patients with IL and 18 age-matched healthy controls were included. High-resolution, motion-corrected T2, T2*, and T2' mapping, CBF mapping (pulsed arterial spin labeling, PASL), and segmentation of GM and WM were used to depict specific changes in both groups. All parameters were compared between patients and healthy controls, using t testing. Values of p < 0.05 were accepted as statistically significant. RESULTS Patients showed significantly increased T2 in lesions (p < 0.01) and in unaffected WM (p = 0.045) as well as significantly increased T2* in lesions (p = 0.003). A significant decrease of T2' was detected in patients in unaffected WM (p = 0.027), while no T2' changes were observed in GM (p = 0.13). Both unaffected WM and GM were significantly decreased in volume in the patient-group (p < 0.01). No differences of PASL-based CBF could be shown. CONCLUSION Non-invasive quantitative MRI with T2, T2*, and T2' mapping might be used to detect subtle structural and metabolic changes in IL. Assessing the grade of microstructural damage and hypoxia might be helpful to monitor disease progression and to perform risk assessment.
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Di Ieva A, Lam T, Alcaide-Leon P, Bharatha A, Montanera W, Cusimano MD. Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives. J Neurosurg 2015. [PMID: 26207600 DOI: 10.3171/2015.1.jns142349] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is still far from consistent in clinical usage. To develop a deeper appreciation for SWI, the authors here review the clinical applications in 4 major fields of neurosurgery: neurooncology, vascular neurosurgery, neurotraumatology, and functional neurosurgery. Finally, they address the limitations of and future perspectives on SWI in neurosurgery.
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Affiliation(s)
| | - Timothy Lam
- Division of Neurosurgery, Department of Surgery; and
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Walter Montanera
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Prominent vessel sign on susceptibility-weighted imaging in acute stroke: prediction of infarct growth and clinical outcome. PLoS One 2015; 10:e0131118. [PMID: 26110628 PMCID: PMC4481350 DOI: 10.1371/journal.pone.0131118] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/28/2015] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose Predicting the risk of further infarct growth in stroke patients is critical to therapeutic decision making. We aimed to predict early infarct growth and clinical outcome from prominent vessel sign (PVS) identified on the first susceptibility-weighted image (SWI) after acute stroke. Materials and Methods Twenty-two patients with middle cerebral artery (MCA) infarction had diffusion-weighted imaging, SWI, MR angiography, and clinical evaluation using the National Institutes of Health Stroke Scale at 7–60 hours and 5–14 days after stroke onset. Late-stage clinical evaluation at 1 and 3 months used the modified Rankin Scale. The infarct area and growth were scored from 10 (none) to 0 (infarct or growth in all 10 zones) using the Alberta Stroke Program Early CT Score (ASPECTS) system. Results Infarct growth on the second MRI occurred in 13 of 15 patients with PVS on the first MRI and not in any patient without PVS (n=7; r=0.86, P<0.001). The extent of PVS was significantly correlated with infarct growth (r=0.82, P<0.001) and early-stage outcome (P=0.02). No between-group difference in late-stage clinical outcome was found. Conclusion PVS on the first SWI after acute MCA territory stroke is a useful predictor of early infarct growth. Extensive PVS within the large MCA territory is related to poor early-stage outcome and could be useful for clinical assessment of stroke.
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Park MG, Yang TI, Oh SJ, Baik SK, Kang YH, Park KP. Multiple hypointense vessels on susceptibility-weighted imaging in acute ischemic stroke: surrogate marker of oxygen extraction fraction in penumbra? Cerebrovasc Dis 2014; 38:254-61. [PMID: 25401484 DOI: 10.1159/000367709] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) are frequently observed in patients with acute cerebral ischemia, but their implication has not been clearly established. To elucidate the clinical significance of MHV on SWI, we investigated the association of MHV on SWI with clinical data and other MR markers in patients with acute ischemic stroke. METHODS We enrolled acute stroke patients with internal carotid or proximal middle cerebral artery occlusion who underwent MRI including SWI within 3 days from stroke onset. Baseline clinical data were reviewed. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). We graded the degree of MHV on SWI as four groups of none, subtle, relative, or extensive by the modified Alberta Stroke Program Early CT Scan (ASPECTS) system. To evaluate the degree of collateral flow, distal hyperintense vessels (DHV) on FLAIR and vessels on post-contrast time-of-flight MR angiography (TOF MRA) source images were graded respectively as 3 groups: none/subtle/prominent and poor/moderate/good. Diffusion and perfusion lesion volume and diffusion-perfusion mismatch (DPM) ratio were measured in all patients. We analyzed the association of the degree of MHV on SWI with clinical data and MR markers. RESULTS Eighty patients were included in the study. The mean MR time from stroke onset was 12.4 h (range 0.5-63.0). There is no difference in MR time from stroke onset between groups of MHV on SWI. MHV were observed in 68 (85%) of 80 patients: none in 12, subtle in 11, relative in 13, and extensive in 44. There were no statistically significant associations between MHV on SWI and vascular risk factors. Patients with more extensive MHV on SWI had a smaller diffusion volume (p < 0.001), larger DPM (p < 0.001), and lower initial NIHSS scores (p = 0.022). Prominent DHV was presented in 29 of 44 patients with extensive MHV (p < 0.001). Good collateral flow on TOF MRA source images was presented in 37 of 44 patients with extensive MHV (p < 0.001). CONCLUSIONS More extensive MHV on SWI in acute ischemic stroke is associated with lower initial NIHSS scores, smaller diffusion lesion volume, better collateral flow, and larger DPM. Our results show the possibility that MHV on SWI may be a useful surrogate marker for predicting increased oxygen extraction fraction and diffusion-perfusion mismatch in acute ischemic hemisphere.
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Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Kim YW, Kim HJ, Choi SH, Kim DC. Prominent hypointense veins on susceptibility weighted image in the cat brain with acute infarction: DWI, SWI, and PWI. Acta Radiol 2014; 55:1008-14. [PMID: 24136983 DOI: 10.1177/0284185113508181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The multiple prominent hypointense veins on susceptibility-weighted imaging (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. Venous side is the unknown area in the hemodynamics of brain infarction. PURPOSE To evaluate the venous aspect in acute brain infarction through an animal study. MATERIAL AND METHODS The acute infarction in cat brains was induced with a bolus infusion of 0.25 mL of triolein through one side of the common carotid artery. The magnetic resonance (MR) images, including diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) map, SW, and perfusion-weighted (PWI) images, were obtained serially at 2 h (n = 17), 1 day (n = 11), and 4 days (n = 4) after triolein infusion. The obtained MR images were evaluated qualitatively and quantitatively. For qualitative assessment, the signal intensity of the serial MR images was evaluated. The presence or absence and the location with serial changes of infarction were identified on DWI and ADC map images. The presence or absence of prominent hypointense veins and the serial changes of cortical veins were also evaluated on SWI. Quantitative assessment was performed by comparing the relative cerebral blood volume (rCBV), cerebral blood flow (rCBF), and mean transit times (MTT) of the lesions with those of the contralateral normal side calculated on PWI. The serial changes of rCBV, rCBF, and MTT ratio were also evaluated. RESULTS Acute infarction in the first and second medial gyrus of lesion hemisphere was found by qualitative evaluation of DWI and ADC map images. On the serial evaluation of SWI, the cortical veins of cat brain with infarction were obscured at 2 h and then re-appeared at 1 day. The hemorrhage transformation and prominent hypointense veins were seen at 4 days on SWI. The quantitative evaluation revealed increased MTT ratios and decreased rCBV and rCBF ratios on PWIs in the acute infarction of cat brain. CONCLUSION The prominent hypointense veins on SWI were seen in the half of the acute infarction at 4 days. The prominent hypointense veins on SWI may have good agreement with the increased MTT ratio.
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Affiliation(s)
- Yong-Woo Kim
- Department of Radiology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hak Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Seon Hee Choi
- Pusan National University Postgraduate School, Pusan, Republic of Korea
| | - Dong Chan Kim
- Seoul National University School of Veterinary Medicine, Seoul, Republic of Korea
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Xia S, Utriainen D, Tang J, Kou Z, Zheng G, Wang X, Shen W, Haacke EM, Lu G. Decreased oxygen saturation in asymmetrically prominent cortical veins in patients with cerebral ischemic stroke. Magn Reson Imaging 2014; 32:1272-6. [PMID: 25131626 DOI: 10.1016/j.mri.2014.08.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/08/2014] [Indexed: 01/28/2023]
Abstract
Decreased oxygen saturation in asymmetrically prominent cortical veins (APCV) seen in ischemic stroke has been hypothesized to correlate with an increase of de-oxygenated hemoglobin. Our goal is to quantify magnetic susceptibility to define APCV by establishing a cutoff above which the deoxyhemoglobin levels are considered abnormal. A retrospective study was conducted on 26 patients with acute ischemic stroke in one cerebral hemisphere that exhibited APCV with 30 age- and sex-matched healthy controls. Quantitative susceptibility mapping (QSM) was used to calculate the magnetic susceptibility of the cortical veins. A paired t-test was used to compare the susceptibility of the cortical veins in the left and right hemispheres for healthy controls as well as in the contralateral hemisphere for stroke patients with APCV. The change in oxygen saturation in the APCV relative to the contralateral side was calculated after thresholding the susceptibility using the mean plus two standard deviations of the contralateral side for each individual. The thresholded susceptibility value of the APCVs in the stroke hemisphere was 254±48 ppb which was significantly higher (p<0.05) than that in the contralateral hemisphere (123±12 ppb) and in healthy controls (125±8 ppb). There was a decrease of oxygen saturation in the APCV ranging from 16% to 44% relative to the veins of the contralateral hemisphere. In conclusion, APCV seen in SWI correspond to reduced levels of oxygen saturation and these abnormal veins can be identified using a susceptibility threshold on the QSM data.
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Affiliation(s)
- Shuang Xia
- Department of Radiology, Nanjing Jinling Hospital,Clinical School, Medical College, Nanjing University, 305 Eastern Zhongshan Rd. Nanjing, China 210002; Department of Radiology, Tianjin First Central Hospital, Tianjin 300192, China
| | - David Utriainen
- Department of Radiology, Magnetic Resonance Imaging Institute for Biomedical Research, Detroit, MI 48202
| | - Jin Tang
- Department of Radiology, Magnetic Resonance Imaging Institute for Biomedical Research, Detroit, MI 48202
| | - Zhifeng Kou
- Department of Radiology, Wayne State University, Detroit, MI 48201
| | - Gang Zheng
- Department of Radiology, Nanjing Jinling Hospital,Clinical School, Medical College, Nanjing University, 305 Eastern Zhongshan Rd. Nanjing, China 210002
| | - Xuesong Wang
- Department of Neurology, Tianjin First Central Hospital, Tianjin 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin 300192, China
| | - E Mark Haacke
- Department of Radiology, Magnetic Resonance Imaging Institute for Biomedical Research, Detroit, MI 48202; Department of Radiology, Wayne State University, Detroit, MI 48201
| | - Guangming Lu
- Department of Radiology, Nanjing Jinling Hospital,Clinical School, Medical College, Nanjing University, 305 Eastern Zhongshan Rd. Nanjing, China 210002.
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Sun W, Liu W, Zhang Z, Xiao L, Duan Z, Liu D, Xiong Y, Zhu W, Lu G, Liu X. Asymmetrical cortical vessel sign on susceptibility-weighted imaging: a novel imaging marker for early neurological deterioration and unfavorable prognosis. Eur J Neurol 2014; 21:1411-8. [PMID: 25040846 DOI: 10.1111/ene.12510] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Susceptibility-weighted imaging (SWI) is a high spatial resolution technique that can indirectly demonstrate increased cerebral oxygen extraction. Our aim was to assess whether asymmetric cortical vessel sign (ACVS) on SWI could be associated with early neurological deterioration (END) as well as 90-day unfavorable outcome in patients with acute ischaemic stroke. MATERIALS AND METHODS Consecutive patients with acute middle cerebral artery (MCA) territory infarction were prospectively enrolled. ACVS was defined as more and/or larger vessels with greater signal loss than those in the opposite hemisphere on minimum intensity projection of SWI. The neurofunctional fluctuation during acute phase as well as 90-day outcomes were assessed. A National Institutes of Health Stroke Scale increment ≥2 points and ≥4 points despite standard treatment in the first 72 h after admission was defined as END2 and END4, respectively. RESULTS In all, 572 patients were finally enrolled. ACVS on SWI was present in 39 (6.8%) subjects. Multivariate analysis indicated that ACVS is an independent predictor for END2 [odds ratio (OR) 4.47, 95% confidence interval (CI) 1.99-10.05) and END4 (OR 4.24, 95% CI 1.94-9.23). Furthermore, ACVS also correlates with 90-day unfavorable outcome defined as a modified Rankin Scale score >1 point (OR 2.93, 95% CI 1.15-7.48). Both positive and negative predictive values of ACVS for END2, END4 and 90-day prognosis were reasonable and both could be slightly enhanced as long as patients with contralateral artery stenosis or occlusion were excluded. CONCLUSION In patients with MCA territory acute ischaemic stroke, especially in those without contralateral internal carotid artery/MCA stenosis or occlusion, ACVS might be considered as a neuroimaging predictor for END and unfavorable prognosis.
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Affiliation(s)
- W Sun
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
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Verma RK, Hsieh K, Gratz PP, Schankath AC, Mordasini P, Zubler C, Kellner-Weldon F, Jung S, Schroth G, Gralla J, El-Koussy M. Leptomeningeal collateralization in acute ischemic stroke: impact on prominent cortical veins in susceptibility-weighted imaging. Eur J Radiol 2014; 83:1448-54. [PMID: 24882785 DOI: 10.1016/j.ejrad.2014.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings. METHODS 33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented. RESULTS 20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p=0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p<0.00). CONCLUSIONS In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill-perfused areas than SWI, especially in good collateralized subjects.
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Affiliation(s)
- Rajeev K Verma
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
| | - Kety Hsieh
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Pascal P Gratz
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian C Schankath
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Zubler
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Frauke Kellner-Weldon
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Gerhard Schroth
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
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Neelavalli J, Mody S, Yeo L, Jella PK, Korzeniewski SJ, Saleem S, Katkuri Y, Bahado-Singh RO, Hassan SS, Haacke EM, Romero R, Thomason ME. MR venography of the fetal brain using susceptibility weighted imaging. J Magn Reson Imaging 2013; 40:949-57. [PMID: 24989457 DOI: 10.1002/jmri.24476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 09/04/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the feasibility of performing fetal brain magnetic resonance venography using susceptibility weighted imaging (SWI). MATERIALS AND METHODS After obtaining informed consent, pregnant women in the second and third trimester were imaged using a modified SWI sequence. Fetal SWI acquisition was repeated when fetal or maternal motion was encountered. The median and maximum number of times an SWI sequence was repeated was four and six respectively. All SWI image data were systematically evaluated by a pediatric neuroradiologist for image quality using an ordinal scoring scheme: 1. diagnostic; 2. diagnostic with artifacts; and 3. nondiagnostic. The best score in an individual fetus was used for further statistical analysis. Visibility of venous vasculature was also scored using a dichotomous variable. A subset of SWI data was re-evaluated by the first and independently by a second pediatric neuroradiologist. Kappa coefficients were computed to assess intra-rater and inter-rater reliability. RESULTS SWI image data from a total of 22 fetuses were analyzed. Median gestational age and interquartile range of the fetuses imaged were 32 (29.9-34.9) weeks. In 68.2% of the cases (n = 15), there was no artifact; 22.7% (n = 5) had minor artifacts and 9.1% (n = 2) of the data was of nondiagnostic quality. Cerebral venous vasculature was visible in 86.4% (n = 19) of the cases. Substantial agreement (Kappa = 0.73; 95% confidence interval 0.44-1.00)) was observed for intra-rater reliability and moderate agreement (Kappa = 0.48; 95% confidence interval 0.19-0.77) was observed for inter-rater reliability. CONCLUSION It is feasible to perform fetal brain venography in humans using SWI.
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Pesaresi I, Sabato M, Desideri I, Puglioli M, Moretti P, Cosottini M. 3.0T MR investigation of CLIPPERS: Role of susceptibility weighted and perfusion weighted imaging. Magn Reson Imaging 2013; 31:1640-2. [DOI: 10.1016/j.mri.2013.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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Jensen-Kondering U, Böhm R. Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke. World J Radiol 2013; 5:156-165. [PMID: 23671751 PMCID: PMC3647207 DOI: 10.4329/wjr.v5.i4.156] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the literature on the assessment of venous vessels to estimate the penumbra on T2*w imaging and susceptibility-weighted imaging (SWI).
METHODS: Literature that reported on the assessment of penumbra by T2*w imaging or SWI and used a validation method was included. PubMed and relevant stroke and magnetic resonance imaging (MRI) related conference abstracts were searched. Abstracts that had overlapping content with full text articles were excluded. The retrieved literature was scanned for further relevant references. Only clinical literature published in English was considered, patients with Moya-Moya syndrome were disregarded. Data is given as cumulative absolute and relative values, ranges are given where appropriate.
RESULTS: Forty-three publications including 1145 patients could be identified. T2*w imaging was used in 16 publications (627 patients), SWI in 26 publications (453 patients). Only one publication used both (65 patients). The cumulative presence of hypointense vessel sign was 54% (range 32%-100%) for T2* (668 patients) and 81% (range 34%-100%) for SWI (334 patients). There was rare mentioning of interrater agreement (6 publications, 210 patients) and reliability (1 publication, 20 patients) but the numbers reported ranged from good to excellent. In most publications (n = 22) perfusion MRI was used as a validation method (617 patients). More patients were scanned in the subacute than in the acute phase (596 patients vs 320 patients). Clinical outcome was reported in 13 publications (521 patients) but was not consistent.
CONCLUSION: The low presence of vessels signs on T2*w imaging makes SWI much more promising. More research is needed to obtain formal validation and quantification.
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Fujioka M, Okuchi K, Iwamura A, Taoka T, Siesjö BK. A mismatch between the abnormalities in diffusion- and susceptibility-weighted magnetic resonance imaging may represent an acute ischemic penumbra with misery perfusion. J Stroke Cerebrovasc Dis 2013; 22:1428-31. [PMID: 23410687 DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 11/20/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022] Open
Abstract
Susceptibility-weighted imaging (SWI) has recently attracted attention for its ability to investigate acute stroke pathophysiology. SWI detects an increased ratio of deoxyhemoglobin to oxyhemoglobin in cerebral venous compartments, which can illustrate cerebral misery perfusion with a compensatory increase of oxygen extraction fraction in the hypoperfused brain. In this study we make the first case report of blunt cervical trauma leading to a stroke, demonstrating the disparity between diffusion-weighted imaging (DWI) and SWI changes, or DWI-SWI mismatch, in the acute ischemic brain. The area of mismatch between a smaller DWI cytotoxic edema and a larger SWI misery perfusion in our patient matured into a complete infarction with time. The DWI-SWI mismatch may signify the presence of an ischemic penumbra, and provide information about viability of the brain tissue at risk of potential infarction if without early reperfusion.
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Affiliation(s)
- Masayuki Fujioka
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan.
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Kao HW, Alexandru D, Kim R, Yanni D, Hasso AN. Value of susceptibility-weighted imaging in acute hemorrhagic leukoencephalitis. J Clin Neurosci 2012; 19:1740-1. [DOI: 10.1016/j.jocn.2011.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/05/2011] [Accepted: 04/05/2011] [Indexed: 10/28/2022]
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Baik SK, Choi W, Oh SJ, Park KP, Park MG, Yang TI, Jeong HW. Change in cortical vessel signs on susceptibility-weighted images after full recanalization in hyperacute ischemic stroke. Cerebrovasc Dis 2012; 34:206-12. [PMID: 23006622 DOI: 10.1159/000342148] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 07/24/2012] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The cortical vessel signs (CVSs) on susceptibility-weighted images (SWIs) have been reported in patients with hyperacute ischemic stroke. We evaluated the change of this susceptibility sign on the immediate SWI after full recanalization and its clinical implications. METHODS Nineteen hyperacute ischemic stroke patients who had acute large artery occlusion and underwent post-recanalization SWI were enrolled in this study. The patients had ICA (internal carotid artery, 2 cases), M1 (M1 segment of middle cerebral artery, 7 cases), M2 (M2 segment of middle cerebral artery, 1 cases), T (intracranial ICA bifurcation, 2 cases), ICA/M1 (4 cases) and basilar artery (3 cases) occlusion on imaging studies before thrombolysis and they underwent immediate magnetic resonance imaging, including the SWI, after full recanalization. The recanalization status was evaluated using the thrombolysis in cerebral infarction (TICI) score before and after thrombolysis. The SWI images were evaluated for the presence of asymmetry of veins over the ischemic territory and this was correlated with the site of stenosis or occlusion. The veins in the ischemic territory were classified as 'prominent' if there were more numerous veins and/or large veins with a greater signal loss observed compared with the opposite normal hemisphere, 'equal' if there were no significant difference in appearance in both the cerebral hemispheres, and 'less' if the veins were decreased in the affected area as compared with that of the normal cortex. Baseline clinical parameters and clinical outcomes were reviewed. RESULTS The initial TICI grades were 0 in all cases. After thrombolysis, TICI grades were 3 in all cases. The pre-recanalization SWIs were obtained in 10 of 19 patients and all 10 showed prominent CVSs over the affected side, which disappeared on the post-recanalization SWI. On the post-recanalization SWI, the observed veins in the affected area were equal (10/19), less (5/19), and both equal and less (4/19). Patients with equal cortical veins in the affected area had small lesions on diffusion-weighted image (DWI) (10/19), while patients with less cortical veins had medium to large lesions on DWI (9/19). CONCLUSION The prominent CVSs on SWI can be indicative of acute thromboembolic occlusion and its change immediately after recanalization can be used to reflect the metabolic status. After recanalization, the appearance of the equal CVS (return to normal) on SWI was associated with a favorable clinical outcome and infarction was avoided in our small series study.
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Affiliation(s)
- Seung Kug Baik
- Department of Diagnostic Radiology, Research Institute for Convergence of Biomedical Science and Technology, Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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Wagner M, Magerkurth J, Volz S, Jurcoane A, Singer OC, Neumann‐Haefelin T, Zanella FE, Deichmann R, Hattingen E. T2′‐ and PASL‐based perfusion mapping at 3 Tesla: influence of oxygen‐ventilation on cerebral autoregulation. J Magn Reson Imaging 2012; 36:1347-52. [DOI: 10.1002/jmri.23777] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 07/20/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marlies Wagner
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Magerkurth
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Steffen Volz
- Brain Imaging Center, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Alina Jurcoane
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Oliver C. Singer
- Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Tobias Neumann‐Haefelin
- Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Friedhelm E. Zanella
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Letourneau-Guillon L, Krings T. Simultaneous arteriovenous shunting and venous congestion identification in dural arteriovenous fistulas using susceptibility-weighted imaging: initial experience. AJNR Am J Neuroradiol 2011; 33:301-7. [PMID: 22051813 DOI: 10.3174/ajnr.a2777] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this short report, we describe the potential contribution of SWI in the noninvasive evaluation of DAVFs. SWI images were compared with DSA for the identification of the location of the fistulous point, the presence of CVR, and the presence of the PPP. In 5 of 6 patients, it was possible to identify the fistulous locations depicted as hyperintensity within venous structures. Cortical venous reflux was underestimated on SWI in 3 cases of robust CVR and not identified in 2 cases of less severe CVR. The PPP seen on angiograms correlated anatomically with increased number, caliber, and tortuosity of hypointense veins seen on SWI. Furthermore, SWI was superior to conventional MR imaging in the detection of these dilated veins. These preliminary results suggest an important role for SWI in the detection and assessment of the complex hemodynamics associated with DAVFs.
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Affiliation(s)
- L Letourneau-Guillon
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
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Yamashita E, Kanasaki Y, Fujii S, Tanaka T, Hirata Y, Ogawa T. Comparison of increased venous contrast in ischemic stroke using phase-sensitive MR imaging with perfusion changes on flow-sensitive alternating inversion recovery at 3 Tesla. Acta Radiol 2011; 52:905-10. [PMID: 21844118 DOI: 10.1258/ar.2011.110159] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Increased venous contrast in ischemic stroke using susceptibility-weighted imaging has been widely reported, although few reports have compared increased venous contrast areas with perfusion change areas. PURPOSE To compare venous contrast on phase-sensitive MR images (PSI) with perfusion change on flow-sensitive alternating inversion recovery (FAIR) images, and to discuss the clinical use of PSI in ischemic stroke. MATERIAL AND METHODS Thirty patients with clinically suspected acute infarction of the middle cerebral artery (MCA) territory within 7 days of onset were evaluated. Phase-sensitive imaging (PSI), flow-sensitive alternating inversion recovery (FAIR), diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) were obtained using 3 Tesla scanner. Two neuroradiologists independently reviewed the MR images, as well as the PSI, DWI, and FAIR images. They were blinded to the clinical data and to each other's findings. The abnormal area of each image was ultimately identified after both neuroradiologists reached consensus. We analyzed areas of increased venous contrast on PSI, perfusion changes on FAIR images and signal changes on DWI for each case. RESULTS Venous contrast increased on PSI and hypoperfusion was evident on FAIR images from 22 of the 30 patients (73%). The distribution of the increased venous contrast was the same as that of the hypoperfused areas on FAIR images in 16 of these 22. The extent of these lesions was larger than that of lesions visualized by on DWI in 18 of the 22 patients. Hypointense signals reflecting hemorrhage and no increased venous contrast on PSI and hyperperfusion on FAIR images were found in six of the remaining eight patients (20%). Findings on PSI were normal and hypoperfusion areas were absent on FAIR images of two patients (7%). CONCLUSION Increased venous contrast on PSI might serve as an index of misery perfusion and provide useful information.
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Affiliation(s)
- Eijiro Yamashita
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - Yoshiko Kanasaki
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - Takuro Tanaka
- Division of Clinical Radiology, Tottori University Hospital, Yonago, Tottori, Japan
| | - Yoshiharu Hirata
- Division of Clinical Radiology, Tottori University Hospital, Yonago, Tottori, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
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Hingwala D, Kesavadas C, Thomas B, Kapilamoorthy TR. Clinical utility of susceptibility-weighted imaging in vascular diseases of the brain. Neurol India 2010; 58:602-7. [PMID: 20739803 DOI: 10.4103/0028-3886.68667] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Susceptibility-weighted imaging (SWI) is a rapidly evolving technique that utilizes both the magnitude and phase information to obtain valuable information about susceptibility changes between tissues. SWI is very sensitive to the paramagnetic effects of deoxyhemoglobin. SWI plays an important role in the diagnostic evaluation and management of acute stroke. In addition, it also plays an important role in the imaging of patients with chronic arterial occlusion and in understanding the effects of chronic infarction, like incomplete infarction and cortical laminar necrosis. The hemodynamic status and oxygen extraction fraction can also be evaluated. SWI is useful in evaluating cerebral venous sinus thrombosis by demonstrating the hemorrhagic venous infarction and thrombus in the sinus and the cortical veins, as well as secondary phenomena like venous stasis in the form of engorged cortical and transmedullary veins and collateral slow flow. Low-flow vascular malformations that are not visualized well on conventional sequences are depicted in exquisite detail along with the venous components on SWI. SWI is used for evaluating cavernomas, developmental venous anomalies, telangiactasias, dural arteriovenous fistulas and the various components of arteriovenous malformations. It has also evolved as a noninvasive technique for evaluating various anomalies of the venous system without administering contrast. Vasculopathies and vasculitis are associated with cerebral microbleeds which are detected on SWI. On the basis of the additional information provided by SWI, it can be included in the routine brain imaging protocol.
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Affiliation(s)
- Divyata Hingwala
- Department of Imaging Sciences and Interventional Radiology, SCTIMST, Trivandrum, India
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