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Jiang S, Cui JY, Yan YY, Yang T, Tao WD, Wu B. Association of compromised cerebral perfusion with lenticulostriate artery impairments in the subacute phase of branch atheromatous disease. Ther Adv Neurol Disord 2022; 15:17562864221109746. [PMID: 35813607 PMCID: PMC9260584 DOI: 10.1177/17562864221109746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background Purpose: Whether altered cerebral perfusion is associated with the pathogenesis of
single subcortical infarctions (SSIs) in the lenticulostriate artery (LSA)
territory remains unclear. Objective: We aimed to assess whether cerebral perfusion abnormalities are related to
LSA impairments in the subacute phase of SSIs and then to examine their
correlations with etiological subtypes of SSIs. Methods: A total of 110 patients with acute SSIs in the LSA territory were
prospectively recruited between July 2017 and October 2021, and they
underwent magnetic resonance perfusion-weighted imaging (PWI) and
whole-brain vessel-wall imaging (VWI) within 7 days of stroke onset. Based
on VWI, patients were assigned to one of two SSI subtypes: branch
atheromatous disease (BAD, n = 78, 70.9%) or lacunar
infarction related to cerebral small vessel disease (CSVD-related LI,
n = 32, 29.1%). Perfusion maps and LSA morphology were
also quantitatively assessed. Results: Based on PWI, 22 patients (20%) had hypoperfusion and 88 (80%) showed normal
perfusion. Compared with normal individuals, patients with hypoperfusion
showed shorter average LSA length (23.48 ± 4.81 mm versus
25.47 ± 3.74 mm, p = 0.037). Compared with patients with
CSVD-related LI, patients with BAD had significantly lower relative cerebral
blood flow [0.95 (IQR 0.81–1.12) versus 1.04 (IQR
0.92–1.22); p = 0.036] and cerebral blood volume [0.95 (IQR
0.84–1.15) versus 1.14 (IQR 0.97–1.27);
p = 0.020] after adjusting for hypertension, number of LSA
branches, and infarct volume. Conclusion: Compromised cerebral perfusion is associated with impairments in the LSA and
with BAD pathogenesis. Perfusion magnetic resonance imaging can provide
important insights into acute SSI pathophysiology, and it may be useful for
determining the clinical significance of perfusion abnormalities in BAD
occurrence.
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Affiliation(s)
- Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Yu Cui
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Ying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Tang Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Dan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan, China
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Cora EA, White PM, Wardlaw JM. Stroke imaging in the age of thrombolysis. IMAGING 2016. [DOI: 10.1259/img.20120004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rudilosso S, Urra X, San Román L, Laredo C, López-Rueda A, Amaro S, Oleaga L, Chamorro Á. Perfusion Deficits and Mismatch in Patients with Acute Lacunar Infarcts Studied with Whole-Brain CT Perfusion. AJNR Am J Neuroradiol 2015; 36:1407-12. [PMID: 25882287 DOI: 10.3174/ajnr.a4303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/22/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence and significance of perfusion abnormalities on brain imaging in patients with lacunar infarct are controversial. We studied the diagnostic yield of CTP and the type of perfusion abnormalities in patients presenting with a lacunar syndrome and in those with MR imaging-confirmed lacunar infarcts. MATERIALS AND METHODS A cohort of 33 patients with lacunar syndrome underwent whole-brain CTP on admission. Twenty-eight patients had an acute ischemic lesion at follow-up MR imaging; 16 were classified as lacunar infarcts. Two independent readers evaluated NCCT and CTP to compare their diagnostic yield. In patients with DWI-confirmed lacunar infarcts and visible deficits on CTP, the presence of mismatch tissue was measured by using different perfusion thresholds. RESULTS The symptomatic acute lesion was seen on CTP in 50% of patients presenting with a lacunar syndrome compared with only 17% on NCCT, and in 62% on CTP compared with 19% on NCCT, respectively, in patients with DWI-confirmed lacunar infarcts. CTP was more sensitive in supratentorial than in infratentorial lesions. In the nonblinded analysis, a perfusion deficit was observed in 12/16 patients with DWI-confirmed lacunar infarcts. The proportion of mismatch tissue was similar in patients with lacunar infarcts or nonlacunar strokes (32% versus 36%, P = .734). CONCLUSIONS Whole-brain CTP is superior to NCCT in identifying small ischemic lesions, including lacunar infarcts, in patients presenting with a lacunar syndrome. Perfusion deficits and mismatch are frequent in lacunar infarcts, but larger studies are warranted to elucidate the clinical significance of these CTP findings.
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Affiliation(s)
- S Rudilosso
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.)
| | - X Urra
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain
| | - L San Román
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - C Laredo
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.)
| | - A López-Rueda
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - S Amaro
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain
| | - L Oleaga
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - Á Chamorro
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain Department of Medicine (Á.C.), School of Medicine, University of Barcelona, Barcelona. Spain
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Mucke J, Möhlenbruch M, Kickingereder P, Kieslich PJ, Bäumer P, Gumbinger C, Purrucker J, Mundiyanapurath S, Schlemmer HP, Bendszus M, Radbruch A. Asymmetry of deep medullary veins on susceptibility weighted MRI in patients with acute MCA stroke is associated with poor outcome. PLoS One 2015; 10:e0120801. [PMID: 25849958 PMCID: PMC4388537 DOI: 10.1371/journal.pone.0120801] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Due to its sensitivity to deoxyhemoglobin, susceptibility weighted imaging (SWI) enables the visualization of deep medullary veins (DMV) in patients with acute stroke, which are difficult to depict under physiological circumstances. This study assesses the asymmetric appearance of prominent DMV as an independent predictor for stroke severity and outcome. MATERIALS AND METHODS SWI of 86 patients with acute middle cerebral artery (MCA) stroke were included. A scoring system from 0 (no visible DMV) to 3 (very prominent DMV) was applied for both hemispheres separately. A difference of scores between ipsi- and contralateral side was defined as asymmetric (AMV+). Occurrence of AMV+ was correlated with the National Institute of Health Stroke Scale (NIHSS) Score on admission and discharge, as well as the modified Rankin Scale (mRS) at discharge. Ordinal regression analysis was used to evaluate NIHSS and mRS as predictors of stroke severity, clinical course of disease and outcome. RESULTS 55 patients displayed AMV+ while 31 did not show an asymmetry (AMV-). Median NIHSS on admission was 17 (11-21) in the AMV+ group and 9 (5-15) in the AMV- group (p = 0.001). On discharge median NIHSS was 11 (5-20) for AMV+ and 5 (2-14) for AMV- (p = 0.005). The median mRS at discharge was 4 (3-5) in the AMV+ group and 3 (1-4) in AMV- (p = 0.001). Odds ratio was 3.19 (95% CI: 1.24-8.21) for AMV+ to achieve a higher mRS than AMV- (p = 0.016). CONCLUSION The asymmetric appearance of DMV on SWI is a fast and easily evaluable parameter for the prediction of stroke severity and can be used as an additional imaging parameter in patients with acute MCA stroke.
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Affiliation(s)
- Johanna Mucke
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
| | - Markus Möhlenbruch
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
| | - Philipp Kickingereder
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
| | - Pascal J. Kieslich
- University of Mannheim, Department of Psychology, Schloss Ehrenhof Ost, 68131 Mannheim, Germany
| | - Philipp Bäumer
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
| | - Christoph Gumbinger
- University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany
| | - Jan Purrucker
- University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany
| | - Sibu Mundiyanapurath
- University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (DKFZ), Department of Radiology, INF 280, 69120 Heidelberg, Germany
| | - Martin Bendszus
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
| | - Alexander Radbruch
- University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), Department of Radiology, INF 280, 69120 Heidelberg, Germany
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Shin DI, Lee HS, Baek SH, Lee SS, Lee SH, Saver JL, Liebeskind DS. Noninvasive Qureshi Grading Scheme Predicts 90-Day mRS in Patients with Acute Ischemic Stroke. J Neuroimaging 2015; 25:761-5. [PMID: 25684593 DOI: 10.1111/jon.12213] [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: 06/18/2014] [Revised: 11/12/2014] [Accepted: 12/10/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Qureshi grading scheme is an effective classification system for evaluating the severity of acute arterial occlusion. However, this scheme is of limited utility because it is based on invasive angiography. In this study, we assessed whether a relationship between a noninvasive Qureshi score, based on magnetic resonance angiography (MRA) or computed tomography angiography (CTA), and 90-day functional outcome could be observed in patients with acute ischemic stroke. METHODS A stroke neurologist evaluated all patients with acute ischemic stroke who presented to the emergency room within 12 hour of symptom onset. Two neurologists independently assessed the noninvasive Qureshi score from initial MRA or CTA. We assessed the relationship between the noninvasive Qureshi grading scheme and clinical outcome on day 90. RESULTS Of a total 125 patients, 75 underwent MRA and 50 underwent CTA. Interobserver reliability showed good agreement (κ = .62). The noninvasive Qureshi score for MRA or CTA and that for CTA alone were directly associated with a good 90-day functional outcome (odds ratio, .672; P = .016 and odds ratio, .511; P = .042). CONCLUSIONS The noninvasive Qureshi scheme using MRA or CTA provides meaningful information about long-term functional outcomes in patients with acute ischemic stroke.
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Affiliation(s)
- Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyung-Suk Lee
- Department of Neurology, Yuseong Sun General Hospital, DaeJeon, Korea
| | - Shin-Hye Baek
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Soo Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Hyun Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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McGehee BE, Pollock JM, Maldjian JA. Brain perfusion imaging: How does it work and what should I use? J Magn Reson Imaging 2012; 36:1257-72. [DOI: 10.1002/jmri.23645] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/17/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
- Blake E. McGehee
- Department of Radiology, Wake Forest University School of Medicine, Winston‐Salem, North Carolina, USA
| | - Jeffrey M. Pollock
- Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph A. Maldjian
- Department of Radiology, Wake Forest University School of Medicine, Winston‐Salem, North Carolina, USA
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Visual assessment of magnetic resonance imaging perfusion lesions in a large patient group. Clin Neuroradiol 2012; 22:305-13. [PMID: 22484907 DOI: 10.1007/s00062-012-0143-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Few magnetic resonance imaging (MRI) studies of stroke have evaluated the value of visual assessment of perfusion/diffusion mismatch, which is crucial for routine application. In this study an attempt was made to visually assess perfusion lesions resembling the acute clinical situation and identify parameters with the highest interobserver reliability when used to define a perfusion/diffusion mismatch and the highest accuracy for prediction of infarct growth. METHODS Magnetic resonance imaging was performed within 6 h of symptom onset and again 1-11 days thereafter in 86 consecutive stroke patients who received intravenous thrombolytic therapy. The MRI protocol included diffusion-weighted imaging apparent diffusion coefficient (DWI/ADC), fluid-attenuated inversion recovery (FLAIR) and perfusion imaging (PI). Maps for different perfusion parameters, e.g. cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) were calculated. Areas of perfusion deficits of all perfusion parameters were visually compared to corresponding ADCs and final infarct size by two independent observers. RESULTS The final infarct size was overestimated by TTP (in 81/83 patients by raters 1 and 2, respectively), MTT (82/83) and CBF (65/74) lesions. The ADC lesions were rated smaller than the final infarct size in 43/38 cases by raters 1 and 2 and the CBV decrease was rated to underestimate final infarct size in 40/31 cases. The only significantly increased OR of 3.883 (95 % CI 1.466-10.819, p = 0.004, rater 1)/5.142 (95 % CI 1.828-15.142, p = 0.001, rater 2) for predicting infarct growth was observed for the presence of a CBV > ADC mismatch, which also showed the highest kappa value of 0.407. CONCLUSIONS All mismatch patterns were prone to high interrater variability when assessed under conditions resembling the clinical setting. Of all tested mismatch patterns the CBV > ADC mismatch was the strongest predictor of lesion growth while visual assessment of TTP and CBF generally resulted in an overestimation of infarct sizes and the presence of a TTP > ADC or CBF > ADC mismatch was not significantly predictive for lesion growth. Visual inspection of these most commonly used mismatch patterns has a low value for the prediction of infarct growth and thus the estimation of the penumbra in ischemic stroke patients.
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Chen F, Ni YC. Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: An update. World J Radiol 2012; 4:63-74. [PMID: 22468186 PMCID: PMC3314930 DOI: 10.4329/wjr.v4.i3.63] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/22/2012] [Accepted: 03/01/2012] [Indexed: 02/06/2023] Open
Abstract
The concept of magnetic resonance perfusion-diffusion mismatch (PDM) provides a practical and approximate measure of the tissue at risk and has been increasingly applied for the evaluation of hyperacute and acute stroke in animals and patients. Recent studies demonstrated that PDM does not optimally define the ischemic penumbra; because early abnormality on diffusion-weighted imaging overestimates the infarct core by including part of the penumbra, and the abnormality on perfusion weighted imaging overestimates the penumbra by including regions of benign oligemia. To overcome these limitations, many efforts have been made to optimize conventional PDM. Various alternatives beyond the PDM concept are under investigation in order to better define the penumbra. The PDM theory has been applied in ischemic stroke for at least three purposes: to be used as a practical selection tool for stroke treatment; to test the hypothesis that patients with PDM pattern will benefit from treatment, while those without mismatch pattern will not; to be a surrogate measure for stroke outcome. The main patterns of PDM and its relation with clinical outcomes were also briefly reviewed. The conclusion was that patients with PDM documented more reperfusion, reduced infarct growth and better clinical outcomes compared to patients without PDM, but it was not yet clear that thrombolytic therapy is beneficial when patients were selected on PDM. Studies based on a larger cohort are currently under investigation to further validate the PDM hypothesis.
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Abstract
The treatment of acute ischaemic stroke is based on the principle that there is ischaemic but still potentially salvageable tissue that could be rescued if blood flow could be restored quickly. It is assumed that salvage might only be possible in the first few hours, and that infarct expansion is a direct result of failed recanalization of the main artery. This concept arose from experimental work in the 1970s, supported more recently by studies using imaging to identify penumbral tissue. However, although magnetic resonance diffusion and perfusion imaging is a way of imaging penumbral tissue and has been around for over a decade, it is not an easy technique to apply in practice and its use has produced conflicting results. Computed tomography perfusion, and any other tissue perfusion imaging technique, is likely to encounter the same difficulties. Indeed many factors, other than the presence of a diffusion-perfusion mismatch acutely, may determine or influence ultimate tissue fate even days after the stroke, and in turn, clinical outcome. Many of these potential influences are beginning to emerge from studies using different forms of imaging at later times after stroke. This review will explore the information now emerging from imaging studies in large artery ischaemic stroke to summarize knowledge to date and indicate unresolved issues for the future.
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Affiliation(s)
- J M Wardlaw
- SINAPSE Collaboration, SFC Brain Imaging Research Centre, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2EX, UK.
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