1
|
Hua VT, Benhammida S, Nguyen TP, Boulouis G, Doucet A, Caucheteux N, Soize S, Moulin S. Brush Sign on pre-treatment imaging is associated with good functional outcome in stroke patients treated with mechanical thrombectomy: A prospective monocentric study. J Neuroradiol 2024; 51:101186. [PMID: 38367958 DOI: 10.1016/j.neurad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The Brush Sign (BrS) is a radiological biomarker (MRI) showing signal decrease of subependymal and deep medullary veins on paramagnetic-sensitive magnetic resonance sequences. Previous studies have shown controversial results regarding the prognostic value of BrS. We aimed to assess whether BrS on T2*-weighted sequences could predict functional prognosis in patients treated with mechanical thrombectomy (MT). METHODS We included all consecutive patients with large artery occlusion related stroke in anterior circulation treated with MT between February 2020 and August 2022 at Reims University Hospital. Multivariable logistic regression models were used to investigate factors associated with BrS and its impact on outcomes. RESULTS Of the 327 included patients, 124 (37,9%) had a BrS on baseline MRI. Mean age was 72 ± 16 years and 184 (56,2 %) were female. In univariate analysis, BrS was associated with a younger age (67 vs 74; p<0.001), a higher NIHSS score (16(10-20) vs 13(8-19); p = 0.047) history of diabetes (15.3% vs 26.1 %; p = 0.022) and a shorter onset to MRI time (145.5 (111.3-188.5) vs 162 (126-220) p = 0.008). In multivariate analyses, patients with a BrS were younger (OR:0.970 (0.951 - 0.989)), tend to have a higher NIHSS score at baseline (OR:1.046 (1.000 - 1.094) and were less likely to have diabetes (OR: 0.433; 0.214-0.879). The presence of BrS was independently associated with functional independence (OR: 2.234(1.158-4,505) at 3 months but not with mortality nor with symptomatic intracerebral hemorrhage. CONCLUSION BrS on pre-treatment imaging could be considered as a biomarker of physiological adaptation to cerebral ischemia, allowing prolonged viability of brain tissue and might participate in the therapeutic decision.
Collapse
Affiliation(s)
- Vi Tuan Hua
- Stroke Unit, Reims University Hospital, Reims, France
| | | | | | | | | | | | | | - Solène Moulin
- Stroke Unit, Reims University Hospital, Reims, France.
| |
Collapse
|
2
|
Bu J, Han X, Wu Y, Lv H, Feng X, Gao D. Correlation between asymmetrical vein sign of SWI and long-term clinical outcomes in patients with middle cerebral artery ischemic stroke. Jpn J Radiol 2024:10.1007/s11604-024-01596-2. [PMID: 38805116 DOI: 10.1007/s11604-024-01596-2] [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: 11/23/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To evaluate the association of asymmetrical cortical vein sign (ACVS) and asymmetrical medullary vein sign (AMVS) on susceptibility-weighted imaging (SWI) with 90-day poor outcomes in patients with unilateral middle cerebral artery acute ischemic stroke (AIS) after conservative drug treatment. METHODS Clinical data for the participants included age, sex, smoking, alcohol, hypertension, diabetes, hyperlipidemia, coronary heart disease, NHISS-admission, and NHISS-discharge scores. Participants underwent magnetic resonance imaging (MRI) within 12 h of hospital admission, including conventional scan sequences and a SWI sequence. Poor prognosis was defined as a modified Rankin scale (mRS) ≥ 3 at 90 days. RESULTS A total of 108 patients were included from January 2021 to March 2022. Twenty-seven (25%) patients had a poor outcome at 90 days. Univariate analysis indicated that diabetes, NHISS-admission, NHISS-discharge, DWI-ASPECTS, SWI-ASPECTS, FLAIR-ASPECTS, and AMVS + were associated with 90-day poor outcome. Multivariate regression analysis showed that AMVS + was associated with 90-day poor outcome from the three models (OR = 3.57, P = 0.006; OR = 3.74, P = 0.005; OR = 5.14, P = 0.0057). However, no significant association was found between ACVS + and 90-day poor outcome. CONCLUSIONS AMVS might be a helpful neuroimaging predictor for poor outcome at 90 days compared to ACVS in drug-conserving treatment of patients with unilateral middle cerebral artery ischemic stroke.
Collapse
Affiliation(s)
- Jingying Bu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuefang Han
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Yankai Wu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Huandi Lv
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuran Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Duo Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China.
| |
Collapse
|
3
|
Kadooka K, Arakaki Y, Kikuchi Y, Matsui H, Mitsutake T, Tanaka M, Kawashima M. Association Between Cerebral Angiography and Asymmetrical Cortical and Deep/Medullary Vein Signs on T2 Star Magnetic Resonance Imaging in Patients with Hyperacute Horizontal Segment of the Middle Cerebral Artery Occlusion. World Neurosurg 2023; 176:e219-e225. [PMID: 37201785 DOI: 10.1016/j.wneu.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND When treating acute ischemic stroke patients, evaluation of collateral flow to the ischemic area is essential. Blood-oxygen-level-dependent imaging, including T2 star (T2∗), can identify elevated deoxyhemoglobin levels, reflecting an increase in the oxygen extraction fraction. Prominent veins on T2∗ represent increased deoxyhemoglobin and cerebral blood volume. This study compared asymmetrical vein signs (AVSs) on T2∗ and digital subtraction angiography findings during mechanical thrombectomy (MT) in patients with hyperacute middle cerebral artery occlusion. METHODS Clinical and imaging data of 41 patients with occlusion of the horizontal segment of the middle cerebral artery who underwent MT were collected. Patients were divided into 2 groups based on angiographic occlusion sites as: proximal and distal to the lenticulostriate artery (LSA). AVSs on T2∗ were divided into asymmetrical cortical vein sign (cortical AVS) and asymmetrical deep/medullary vein sign (deep/medullary AVS), and were compared with the findings of intraoperative digital subtraction angiography. RESULTS Twenty-seven patients had AVSs. Cortical AVS was the only parameter with a significant association with poor angiographic collateral supply. In terms of occlusion site, deep/medullary AVS was the only parameter with a significant association with occlusion proximal to the LSA. CONCLUSIONS In patients with occlusion of the horizontal segment of the middle cerebral artery, presence of the cortical AVS on T2∗ suggests a poor angiographic collateral supply, while presence of the deep/medullary AVS suggests impaired blood flow to the basal ganglia through LSAs. Both these signs contribute to poor outcomes in patients undergoing MT.
Collapse
Affiliation(s)
- Keisuke Kadooka
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan; International University of Health and Welfare Graduate School, Narita, Chiba, Japan.
| | - Yoshito Arakaki
- Department of Neurology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yoichi Kikuchi
- Department of Radiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda Institute for Health Science, Kameda College of Health Sciences, Kamogawa, Chiba, Japan
| | - Takafumi Mitsutake
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Michihiro Tanaka
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masatou Kawashima
- International University of Health and Welfare Graduate School, Narita, Chiba, Japan
| |
Collapse
|
4
|
Seifert K, Heit JJ. Collateral Blood Flow and Ischemic Core Growth. Transl Stroke Res 2023; 14:13-21. [PMID: 35699917 DOI: 10.1007/s12975-022-01051-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 01/31/2023]
Abstract
Treatment of a large vessel occlusion in the acute ischemic stroke setting focuses on vessel recanalization, and endovascular thrombectomy results in favorable outcomes in appropriate candidates. Expeditious treatment is imperative, but patients often present to institutions that do not have neurointerventional surgeons and need to be transferred to a comprehensive stroke center. These treatment delays are common, and it is important to identify factors that mitigate the progression of the ischemic core in order to maximize the preservation of salvageable brain tissue. Collateral blood flow is the strongest factor known to influence ischemic core growth, which includes the input arterial vessels, tissue-level vessels, and venous outflow. Collateral blood flow at these different levels may be imaged by specific imaging techniques that may also predict ischemic core growth during treatment delays and help identify patients who would benefit from transfer and endovascular therapy, as well as identify those patients in whom transfer may be futile. Here we review collateral blood flow and its relationship to ischemic core growth in stroke patients.
Collapse
Affiliation(s)
- Kimberly Seifert
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA. .,Radiology and Neurosurgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| |
Collapse
|
5
|
Bani-Sadr A, Pavie D, Mechtouff L, Cappucci M, Hermier M, Ameli R, Derex L, De Bourguignon C, Cho TH, Eker O, Nighoghossian N, Berthezene Y. Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy. Eur Radiol 2023; 33:4502-4509. [PMID: 36633674 DOI: 10.1007/s00330-022-09387-x] [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: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy. METHODS HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4. RESULTS One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (p = 0.01) and larger FIV (p = 0.02). Good collaterals were associated with a smaller baseline ischemic core (p < 0.001), larger penumbra (p = 0.04), and smaller FIV (p < 0.001). Collateral status was not significantly associated with brush sign (p = 0.20) or with infarct growth (p = 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3]; p = 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6]; p = 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8-16.6], p = 0.006). CONCLUSIONS Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not. KEY POINTS • Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy. • Our results suggest that the brush sign-a surrogate marker of severe hypoperfusion-is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not.
Collapse
Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France. .,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,Research On Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University. Domaine Rockfeller, 8 Avenue Rockfeller, 69373 Cedex 08, Lyon, France
| | | | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| |
Collapse
|
6
|
Rascle L, Bani Sadr A, Amaz C, Mewton N, Buisson M, Hermier M, Ong E, Fontaine J, Derex L, Berthezène Y, Eker OF, Cho TH, Nighoghossian N, Mechtouff L. Does the Brush-Sign Reflect Collateral Status and DWI-ASPECTS in Large Vessel Occlusion? Front Neurol 2022; 13:828256. [PMID: 35309551 PMCID: PMC8924293 DOI: 10.3389/fneur.2022.828256] [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: 12/03/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact on baseline diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT). Methods Consecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score. Results In this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status [72 (42.1%) vs. 103 (30.9%); p = 0.017]. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 7 while the latter remained associated with younger age [odds ratio (OR) 0.97, 95% CI.96–0.99], male sex (OR 1.79, 95% CI 1.08–2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1–1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25–5.38), and intracranial ICA (OR 3.01, 95% CI 1.16–8) occlusion. Conclusions and Relevance The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT04620642.
Collapse
Affiliation(s)
- Lucie Rascle
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Nathan Mewton
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
- *Correspondence: Laura Mechtouff
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Bhattacharjee R, Gupta RK, Das B, Dixit VK, Gupta P, Singh A. Penumbra quantification from MR SWI-DWI mismatch and its comparison with MR ASL PWI-DWI mismatch in patients with acute ischemic stroke. NMR IN BIOMEDICINE 2021; 34:e4526. [PMID: 33880799 DOI: 10.1002/nbm.4526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
In acute-ischemic-stroke patients, penumbra assessment plays a significant role in treatment outcome. MR perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) mismatch ratio can provide penumbra assessment. Recently reported studies have shown the potential of susceptibility-weighted imaging (SWI) in the qualitative assessment of penumbra. We hypothesize that quantitative penumbra assessment using SWI-DWI can provide an alternative to the PWI-DWI approach and this can also reduce the overall scan-time. The purpose of the current study was to develop a framework for accurate quantitative assessment of penumbra using SWI-DWI and its validation with PWI-DWI-based quantification. In the current study, the arterial-spin-labelling (ASL) technique has been used for PWI. This retrospective study included 25 acute-ischemic-stroke patients presenting within 24 hours of the last noted baseline condition of stroke onset. Eleven patients also had follow-up MRI within 48 hours. MRI acquisition comprised DWI, SWI, pseudo-continuous-ASL (pCASL), FLAIR and non-contrast-angiography sequences. A framework was developed for the enhancement of prominent hypo-intense vein signs followed by automatic segmentation of the SWI penumbra ROI. Apparent-diffusion-coefficient (ADC) maps and cerebral-blood-flow (CBF) maps were computed. The infarct core ROI from the ADC map and the ASL penumbra ROI from CBF maps were segmented semiautomatically. The infarct core volume, SWI penumbra volume (SPV) and pCASL penumbra volume were computed and used to calculate mismatch ratios MRSWIADC and MRCBFADC . The Dice coefficient between the SWI penumbra ROI and ASL penumbra ROI was 0.96 ± 0.07. MRSWIADC correlated well (r = 0.90, p < 0.05) with MRCBFADC , which validates the hypothesis of accurate penumbra assessment using the SWI-DWI mismatch ratio. Moreover, a significant association between high SPV and the presence of vessel occlusion in the MR angiogram was observed. Follow-up data showed salvation of penumbra tissue (location and volumes predicted by proposed framework) by treatments. Additionally, functional-outcome analysis revealed 93.3% of patients with MRSWIADC > 1 benefitted from revascularization therapy. Overall, the proposed automated quantitative assessment of penumbra using the SWI-DWI mismatch ratio performs equivalently to the ASL PWI-DWI mismatch ratio. This approach provides an alternative to the perfusion sequence required for penumbra assessment, which can reduce scan time by 17% for the protocol without a perfusion sequence.
Collapse
Affiliation(s)
- Rupsa Bhattacharjee
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Philips Health System, Philips India Limited, Gurugram, India
| | - Rakesh Kumar Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurugram, India
| | - Biplab Das
- Department of Interventional Neuroradiology, Fortis Memorial Research Institute, Gurugram, India
- Department of Neurology, Fortis Memorial Research Institute, Gurugram, India
| | - Vijay Kant Dixit
- Department of Interventional Neuroradiology, Fortis Memorial Research Institute, Gurugram, India
| | - Praveen Gupta
- Department of Neurology, Fortis Memorial Research Institute, Gurugram, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Guenego A, Leipzig M, Fahed R, Sussman ES, Faizy TD, Martin BW, Marcellus DG, Wintermark M, Olivot JM, Albers GW, Lansberg MG, Heit JJ. Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR). Front Neurol 2021; 11:618765. [PMID: 33488506 PMCID: PMC7815586 DOI: 10.3389/fneur.2020.618765] [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: 10/18/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage. Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables such as baseline-core-infarct volume [mL], arterial collaterals (HIR: TMax > 10 s volume/TMax > 6 s), high oxygen extraction (HOE, presence of the brush-sign on T2*) were assessed. A linear-regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables. Results: We included 103 patients. Median age was 70 (58–78), and 63% were female. Median baseline-core-infarct volume was 32 ml (IQR 8–74.5). Seventy six patients (74%) had HOE. In a multivariate analysis both favorable HIR collaterals (p = 0.02) and HOE (p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR (p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct. Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood-flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage.
Collapse
Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Matthew Leipzig
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Robert Fahed
- Division of Neurology, Department of Medicine, Ottawa Hospital, Ottawa, ON, Canada
| | - Eric S Sussman
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Tobias D Faizy
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Blake W Martin
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | | | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Elsaid N, Mustafa W, Saied A. Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis. Neuroradiol J 2020; 33:118-133. [PMID: 31971093 PMCID: PMC7140299 DOI: 10.1177/1971400919900275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.
Collapse
Affiliation(s)
- Nada Elsaid
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Wessam Mustafa
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Ahmed Saied
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| |
Collapse
|
12
|
Liang J, Gao P, Lin Y, Song L, Qin H, Sui B. Susceptibility-weighted imaging in post-treatment evaluation in the early stage in patients with acute ischemic stroke. J Int Med Res 2018; 47:196-205. [PMID: 30238823 PMCID: PMC6384492 DOI: 10.1177/0300060518799019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective This study aimed to investigate the association between abnormal signs on susceptibility-weighted imaging (SWI) and post-treatment outcome in the early stage in patients with acute ischemic stroke. Methods Thirty-seven patients with middle cerebral artery territory infarction were recruited. Baseline and 24-hour follow-up magnetic resonance imaging was performed. Pre- and 24-hour post-treatment clinical conditions were assessed with the National Institutes of Health Stroke Scale (NIHSS) score. Prominent vessel sign (PVS) on SWI and infarcted areas on diffusion-weighted imaging (DWI) were assessed using the Alberta Stroke Program Early CT (ASPECT) score system. Susceptibility vessel sign (SVS) was evaluated and recorded. The associations between image abnormalities and clinical scores were analyzed. Results PVS was found in 35 patients and SVS in seven patients. The extent of PVS was significantly correlated with the post-treatment DWI ASPECT score (r = 0.79), but not with the post-treatment NIHSS score or the post−pre NIHSS difference score. The presence of SVS was significantly correlated with the post-treatment NIHSS score (r = 0.41). Conclusion PVS might be a useful predictor of early imaging prognosis and infarct growth in patients with acute ischemic stroke. SVS is related to a poor early outcome and could be useful for assessing stroke.
Collapse
Affiliation(s)
- Jia Liang
- 1 Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiyi Gao
- 1 Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,2 Radiology Department, Beijing Neurosurgical Institute, Beijing, China.,3 Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yan Lin
- 2 Radiology Department, Beijing Neurosurgical Institute, Beijing, China
| | - Ligang Song
- 4 Interventional Neurology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haiqiang Qin
- 5 Neurology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- 1 Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,2 Radiology Department, Beijing Neurosurgical Institute, Beijing, China.,3 Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| |
Collapse
|
13
|
Zamora C, Hung SC, Tomingas C, Atkinson C, Castillo M. Engorgement of Deep Medullary Veins in Neurosarcoidosis: A Common-Yet-Underrecognized Cerebrovascular Finding on SWI. AJNR Am J Neuroradiol 2018; 39:2045-2050. [PMID: 30237298 DOI: 10.3174/ajnr.a5783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
We describe the prevalence and potential significance of deep medullary vein engorgement on SWI in patients with neurosarcoidosis, a finding that has not been described previously. Engorgement was evaluated for possible associations with meningeal or perivascular disease, intracranial hemorrhage, and venous thrombosis, as well as with modified Rankin Scale scores at the time of MR imaging and at follow-up. Deep medullary vein engorgement was seen in 7 of 21 patients and was more common in men. Patients with venous engorgement had a significantly increased incidence of microhemorrhages, perivascular disease, and hydrocephalus. There was no association with the degree of leptomeningeal disease, venous dural sinus thrombosis, or modified Rankin Scale scores. In conclusion, deep medullary vein engorgement was common in our patients with neurosarcoidosis. Although its pathophysiology remains uncertain, it could be related to venous or perivenous abnormalities and may represent a useful secondary finding of cerebrovascular disease.
Collapse
Affiliation(s)
- C Zamora
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - S-C Hung
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - C Tomingas
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - C Atkinson
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - M Castillo
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Li L, Liu MS, Li GQ, Zheng Y, Guo TL, Kang X, Yuan MT. Susceptibility-weighted Imaging in Thrombolytic Therapy of Acute Ischemic Stroke. Chin Med J (Engl) 2018; 130:2489-2497. [PMID: 29052571 PMCID: PMC5684633 DOI: 10.4103/0366-6999.216401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke. Study Selection: Papers in English or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors’ files. Results: SWI is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign (SVS) on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectomy in combination or alone. SWI is sensitive in detecting cerebral microbleed (CMB), and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple foci could possibly be related to intracranial hemorrhage (ICH) after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions: It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
Collapse
Affiliation(s)
- Lin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Su Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Guang-Qin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yang Zheng
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Tong-Li Guo
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Xin Kang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Mao-Ting Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
15
|
Duan Y, Xu Z, Li H, Cai X, Chang C, Yang B. Prominent deep medullary veins: a predictive biomarker for stroke risk from transient ischemic attack? Acta Radiol 2018; 59:606-611. [PMID: 28814097 DOI: 10.1177/0284185117726813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Deep medullary veins (DMVs) are a biomarker of severity and prognosis in patients with acute cerebral infarction. However, their clinical significance remains unclear in patients with transient ischemic attack (TIA). Purpose To determine whether prominent deep medullary veins (PDMVs) are a predictive biomarker for stroke risk after TIA. Material and Methods Clinical and imaging data of 49 patients with TIA and 49 sex- and age-matched controls were studied. PDMVs were defined as DMVs with a score of 3 (TDMVs) or asymmetric DMVs (ADMVs), and the relationship between PDMVs and clinical features was analyzed. The DMV score based on susceptibility weighted imaging (SWI) ranged from 0 (not visible) to 3 (very prominent) and was calculated for both hemispheres separately. A different score in each hemisphere was defined as ADMVs and an equal score was defined as symmetric DMVs. The asymmetry and score of DMVs were compared between the two groups and with respect to the time from TIA onset to imaging analysis. Results Agreement between neuroradiologists for the DMV asymmetry/score on SWI was excellent. The frequency of ADMVs and TDMVs was significantly higher in patients with TIA than controls ( P < 0.05). The patients showed no correlation between the time from TIA onset to imaging and the DMV asymmetry/score ( P > 0.05); PDMVs were not correlated with age, blood pressure, or diabetes. However, PDMVs were associated with the ABCD2 score (≥4), clinical symptoms, and duration of TIA (≥10 min). Conclusion Prominent deep medullary veins is a predictive biomarker for the risk of stroke in many patients having suffered from TIA.
Collapse
Affiliation(s)
- Yang Duan
- Department of Radiology, General Hospital of Shenyang Military Area Command, Shenyang, PR China
| | - Zhihua Xu
- Jinzhou Medical University, General Hospital of Shenyang Military Area Command Training Base for Graduate, Shenyang, PR China
| | - Hongyi Li
- Department of Radiology, General Hospital of Shenyang Military Area Command, Shenyang, PR China
| | - Xiaonan Cai
- Dalian Medical University, General Hospital of Shenyang Military Area Command Training Base for Graduate, Shenyang, PR China
| | - Cancan Chang
- Department of Radiology, General Hospital of Shenyang Military Area Command, Shenyang, PR China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Shenyang Military Area Command, Shenyang, PR China
| |
Collapse
|
16
|
Wang Y, Shi T, Chen B, Lin G, Xu Y, Geng Y. Prominent Hypointense Vessel Sign on Susceptibility-Weighted Imaging Is Associated with Clinical Outcome in Acute Ischaemic Stroke. Eur Neurol 2018; 79:231-239. [PMID: 29672289 DOI: 10.1159/000488587] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prominent hypointense vessel sign (PHVS) is visualized on susceptibility weighted-imaging (SWI) in acute ischaemic stroke (AIS). We aim to test if PHVS is associated with stroke outcome. METHODS Forty patients with acute middle cerebral artery occlusion were recruited. The presence of PHVS, cortical vessel sign (CVS), brush sign (BS) and susceptibility-diffuse weighted imaging mismatch (S-D mismatch) and Alberta Stroke Program Early CT Score (ASPECTS) on SWI were compared between the good outcome group (90-day modified Rankin scale [mRS] of 0-2) and the poor outcome group (mRS of 3-6). The receiver operating characteristic curves (ROC) were used to evaluate the predictive ability to poor outcome of above imaging characteristics. RESULTS The presence of PHVS, CVS, BS and S-D mismatch was significantly higher in the poor outcome group (p < 0.001, p = 0.001, p = 0.013, p = 0.014, respectively). SWI-ASPECTS was significantly lower in the poor outcome group (p = 0.002). Regression analysis revealed SWI-ASPECTS; the presence of PHVS and CVS were independently associated with poor outcome (OR 0.347, p = 0.012; OR 55.77, p = 0.004; OR 58.05, p = 0.005). ROC analysis showed that PHVS had the highest predictive value for poor outcome (AUC 0.783). CONCLUSIONS The presence of PHVS, CVS and SWI-ASPECTS were associated with poor outcome in AIS. The presence of PHVS was the most effective radiographic marker for predicting outcome.
Collapse
|
17
|
Wang T, Zhu L, Hu C, Gong S, Jiang H, Chen H, Li J. The diagnostic value of susceptibility-weighted imaging for ischemic penumbra in patients with acute ischemic stroke. Technol Health Care 2017; 25:449-457. [PMID: 28582933 DOI: 10.3233/thc-171348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ischemia penumbra area is not easy to be detected accurately using noninvasive imaging methods. OBJECTIVE We aim to assess the diagnostic value of susceptibility-weighted imaging (SWI) for ischemic penumbra in patients with acute ischemic stroke. METHODS A retrospective analysis was carried out in 47 patients with ischemic stroke involving the middle cerebral artery. Mean transit time (MTT), time to peak, relative cerebral blood flow, and relative cerebral blood volume maps were created after image processing. RESULTS No significant difference was found in the mismatch between the SWI and diffusion-weighted imaging (SWI-DWI) or in the MTT-DWI mismatch scores (P= 0.056, Kappa = 0.864). CONCLUSIONS SWI provides information comparable to PWI and, thus, could serve as a reliable magnetic resonance technique for assessing ischemic penumbrae.
Collapse
Affiliation(s)
- Tianle Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Li Zhu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shenchu Gong
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hongbiao Jiang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Haitao Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jia Li
- Department of Neurology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Zhang X, Zhang S, Chen Q, Ding W, Campbell BCV, Lou M. Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2017; 38:875-881. [PMID: 28302608 DOI: 10.3174/ajnr.a5135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The impact of deep cerebral veins on neurologic outcome after intravenous thrombolysis in patients with acute ischemic stroke is unclear. We investigated the relationship between the appearance of deep cerebral veins on susceptibility-weighted imaging and neurologic outcome in patients who underwent thrombolysis. MATERIALS AND METHODS We retrospectively analyzed 109 consecutive patients with acute ischemic stroke who had pretreatment SWI and received intravenous thrombolysis within 6 hours. We calculated the signal difference ratio (defined as the relative difference in signal intensity between the ipsilateral and contralateral veins) of the thalamostriate vein, septal vein, and internal cerebral vein on pretreatment SWI. RESULTS Only the signal difference ratio of the thalamostriate vein was significantly associated with poor outcome (3-month modified Rankin Scale score > 2, P = .008). The optimal threshold was relative hypointensity of the ipsilateral vein of >4.8% (sensitivity of 53.7% and specificity of 80.9%). We defined a signal difference ratio of the thalamostriate vein of ≥5% as an ipsilateral prominent thalamostriate vein. Patients with an ipsilateral prominent thalamostriate vein were more likely to have poor outcome (OR = 3.66; 95% CI, 1.25-10.68; P = .02) and a lower rate of successful reperfusion (reperfusion rate of ≥70%; OR = 0.35; 95% CI, 0.13-0.92; P = .03), compared with those without an ipsilateral prominent thalamostriate vein. However, patients with an ipsilateral prominent thalamostriate vein were still less likely to experience poor outcome when reperfusion was achieved compared with when reperfusion did not occur (80.0% versus 44.4%, P = .04). CONCLUSIONS A pretreatment ipsilateral prominent thalamostriate vein was associated with reduced reperfusion after thrombolysis and poor outcome. More intensive reperfusion approaches may be required for patients with an ipsilateral prominent thalamostriate vein.
Collapse
Affiliation(s)
- X Zhang
- From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.)
| | - S Zhang
- From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.)
| | - Q Chen
- From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.)
| | - W Ding
- Radiology (W.D.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - B C V Campbell
- Department of Neurology (B.C.V.C.), Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia
| | - M Lou
- From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.)
| |
Collapse
|
20
|
Payabvash S, Benson JC, Taleb S, Rykken JB, Hoffman B, Oswood MC, McKinney AM. Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke. Br J Radiol 2017; 89:20160714. [PMID: 27805839 DOI: 10.1259/bjr.20160714] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke. METHODS Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined. RESULTS Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k = 0.314-0.338, p ≤ 0.001) for grading, and moderate agreement (k = 0.406-0.413, p ≤ 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho = 0.232, p = 0.001; rho = 0.180, p = 0.008; respectively) and larger infarct volume (rho = 0.445, p < 0.001; rho = 0.167, p = 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p = 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p < 0.001). CONCLUSION There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).
Collapse
Affiliation(s)
| | - John C Benson
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shayandokht Taleb
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| |
Collapse
|
21
|
于 永. Cerebral Microbleeds Screening with Original Image of 3D-TOF MRA Sequences Predicting Hemorrhagic Transformation in the Patients with Cerebral Infarction. ACTA ACUST UNITED AC 2017. [DOI: 10.12677/ijpn.2017.63004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Munuera J, Blasco G, Hernández-Pérez M, Daunis-I-Estadella P, Dávalos A, Liebeskind DS, Wintermark M, Demchuk A, Menon BK, Thomalla G, Nael K, Pedraza S, Puig J. Venous imaging-based biomarkers in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2017; 88:62-69. [PMID: 27807197 DOI: 10.1136/jnnp-2016-314814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 11/04/2022]
Abstract
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2* -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.
Collapse
Affiliation(s)
- Josep Munuera
- Diagnostic Imaging Institute (IDI), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Gerard Blasco
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
| | | | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Antoni Dávalos
- Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, California, USA
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California, USA
| | - Andrew Demchuk
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Salvador Pedraza
- Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain.,Institute of Diagnostic Imaging (IDI)-Dr. Josep Trueta University Hospital, Girona, Spain
| | - Josep Puig
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
| |
Collapse
|
23
|
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.
Collapse
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.)
| |
Collapse
|
24
|
Karaszewski B, Houlden H, Smith EE, Markus HS, Charidimou A, Levi C, Werring DJ. What causes intracerebral bleeding after thrombolysis for acute ischaemic stroke? Recent insights into mechanisms and potential biomarkers. J Neurol Neurosurg Psychiatry 2015; 86:1127-36. [PMID: 25814492 DOI: 10.1136/jnnp-2014-309705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/02/2015] [Indexed: 12/17/2022]
Abstract
The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated patients who are harmed by early symptomatic intracranial haemorrhage (ICH). Although several clinical and radiological factors increase the risk of rtPA-related ICH, none of the currently available risk prediction tools are yet useful for practical clinical decision-making, probably reflecting our limited understanding of the underlying mechanisms. Finding new methods to identify patients at highest risk of rtPA-related ICH, or new measures to limit risk, are urgent challenges in acute stroke therapy research. In this article, we focus on the potential underlying mechanisms of rtPA-related ICH, highlight promising candidate risk biomarkers and suggest future research directions.
Collapse
Affiliation(s)
- Bartosz Karaszewski
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre, Gdansk, Poland
| | - Henry Houlden
- Department of Molecular Neuroscience, University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, London, UK
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Hugh S Markus
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Andreas Charidimou
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK
| | - Christopher Levi
- Acute Stroke Services, University of Newcastle, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David J Werring
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK
| |
Collapse
|
25
|
MR image features predicting hemorrhagic transformation in acute cerebral infarction: a multimodal study. Neuroradiology 2015; 57:1145-52. [DOI: 10.1007/s00234-015-1575-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/07/2015] [Indexed: 11/27/2022]
|
26
|
Ibatullin MM, Kalinin MN, Curado AT, Khasanova DR. [Neurovisualisation predictors of malignant cerebral infarction and hemorrhagic transformation]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:3-11. [PMID: 26120991 DOI: 10.17116/jnevro2015115323-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuroimaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of malignant middle cerebral artery infarction and hemorrhagic transformation in light of the aforementioned four Ps.
Collapse
Affiliation(s)
| | | | - A T Curado
- Interregional Clinical Diagnostic Center, Kazan
| | | |
Collapse
|
27
|
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.
Collapse
|
28
|
Lövblad KO, Altrichter S, Mendes Pereira V, Vargas M, Marcos Gonzalez A, Haller S, Sztajzel R. Imaging of acute stroke: CT and/or MRI. J Neuroradiol 2015; 42:55-64. [DOI: 10.1016/j.neurad.2014.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
|
29
|
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.
Collapse
Affiliation(s)
- W Sun
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Lou M, Chen Z, Wan J, Hu H, Cai X, Shi Z, Sun J. Susceptibility-diffusion mismatch predicts thrombolytic outcomes: a retrospective cohort study. AJNR Am J Neuroradiol 2014; 35:2061-7. [PMID: 25012670 DOI: 10.3174/ajnr.a4017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Asymmetric hypointensity of cerebral veins on susceptibility-weighted imaging has been shown to indirectly reflect tissue hypoxia after cerebral ischemia. We therefore investigated whether patients with prominent asymmetry of the cerebral veins on SWI and a relatively small diffusion-weighted imaging lesion (SWI-DWI mismatch), representing the presence of salvageable tissue, were more likely to benefit from thrombolytic therapy. MATERIALS AND METHODS We conducted a retrospective study of the anterior circulation of patients with ischemic stroke with SWI/DWI acquired before thrombolysis. The asymmetry index was defined as the ratio of cerebral vein voxel count between the ischemic and normal hemisphere on the SWI phase map. We defined SWI-DWI mismatch as an asymmetry index score of ≥1.75 with a DWI lesion volume of ≤25 mL. Favorable outcome was defined as modified Rankin Scale 0-2 at 3 months. Univariate and multivariate logistic regression analyses were used to examine the association between the mismatch profile and favorable outcome. RESULTS Fifty-four patients undergoing thrombolytic treatment were enrolled in this study. The rate of favorable outcome was significantly higher among patients with baseline SWI-DWI mismatch compared with those without (78% versus 44%; adjusted odds ratio, 6.317; 95% CI, 1.12-35.80; P = .037). Patients with SWI-DWI mismatch were also more likely to have a favorable outcome from reperfusion (91% versus 43%, P = .033) or recanalization (100% versus 40%, P = .013). The accuracy of SWI-DWI mismatch for predicting favorable outcome was higher than that of perfusion-diffusion mismatch (63% versus 48.1%). CONCLUSIONS The presence of SWI-DWI mismatch may identify patients with ischemia who would benefit from early reperfusion therapy.
Collapse
Affiliation(s)
- M Lou
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - Z Chen
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - J Wan
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - H Hu
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - X Cai
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - Z Shi
- From the Departments of Neurology (M.L., Z.C., J.W., H.H., X.C., Z.S.)
| | - J Sun
- Radiology (J.S.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
| |
Collapse
|
31
|
Sharma VK, Yeo LLL, Teoh HL, Shen L, Chan BPL, Seet RC, Ahmad A, Chong VF, Paliwal PR. Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome. J Stroke Cerebrovasc Dis 2013; 23:e39-45. [PMID: 24119628 DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/08/2013] [Accepted: 08/11/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. METHODS Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/neuroradiologists. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. RESULTS Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intravenous thrombolysis. The median age was 65 years (range 19-92), 44% were men, and median National Institutes of Health Stroke Scale (NIHSS) score was 16 points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) patients, whereas 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.079-1.201, P = .046), change in NIHSS score during first 24 hours (OR .737; 95% CI .672-.807, P < .0001), and ICV asymmetry on follow-up CTA (OR 20.3; 95% CI 4.67-52.07, P < .0001) independently predicted poor outcome at 3 months. CONCLUSIONS ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.
Collapse
Affiliation(s)
- Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock L Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Raymond C Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aftab Ahmad
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vincent F Chong
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| |
Collapse
|
32
|
Tada Y, Uno M, Matsubara S, Suzue A, Shimada K, Morita N, Harada M, Nagahiro S. Reversibility of ischemic findings on 3-T T2*-weighted imaging after emergency superficial temporal artery-middle cerebral artery anastomosis in patients with progressive ischemic stroke. Neurol Med Chir (Tokyo) 2013; 50:1006-11. [PMID: 21123987 DOI: 10.2176/nmc.50.1006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Vascular ischemic signs, i.e. multiple hypointense vessels in the ischemic territory, were identified by gradient echo-type 3-T T(2)*-weighted magnetic resonance (MR) imaging in 3 patients with acute ischemia due to major vessel occlusion. Emergency superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 2 patients with progressive stroke caused by bleeding-type moyamoya disease or severe MCA stenosis. Both patients were initially treated conservatively, but their neurological signs deteriorated. 3-T T(2)*-weighted MR imaging detected funicular low signals in both patients indicating enhancement of cortical vessels or medullary veins. The area of the vascular ischemic signs was almost the same or smaller than the hypoperfusion area on perfusion-weighted MR imaging or single-photon emission computed tomography. Postoperatively, the vascular ischemic signs disappeared in both patients, suggesting a relationship with severe ischemia due to high-risk misery perfusion. Their postoperative course was uneventful, and MR imaging revealed no new cerebral ischemic lesions or cerebral hyperperfusion. The patient without surgery developed cerebral infarction in the area of the vascular ischemic signs. Vascular ischemic signs detected by 3-T T(2)*-weighted MR imaging may represent a new predictor of high-risk misery perfusion, and may disappear after STA-MCA anastomosis performed in the subacute stage.
Collapse
Affiliation(s)
- Yoshiteru Tada
- Department of Neurosurgery, School of Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
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: 35] [Impact Index Per Article: 3.2] [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.
Collapse
|
34
|
Weiser RE, Sheth KN. Clinical Predictors and Management of Hemorrhagic Transformation. Curr Treat Options Neurol 2013; 15:125-49. [DOI: 10.1007/s11940-012-0217-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
35
|
Sohn CH, Lee HP, Park JB, Chang HW, Kim E, Kim E, Park UJ, Kim HT, Ku J. Imaging findings of brain death on 3-tesla MRI. Korean J Radiol 2012; 13:541-9. [PMID: 22977320 PMCID: PMC3435850 DOI: 10.3348/kjr.2012.13.5.541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 01/20/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate the usefulness of 3-tesla (3T) magnetic resonance imaging (MRI) including T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), time-of-flight (TOF) magnetic resonance angiography (MRA), T2*-weighted gradient recalled echo (GRE), and susceptibility weighted imaging (SWI) in diagnosing brain death. MATERIALS AND METHODS Magnetic resonance imaging findings for 10 patients with clinically verified brain death (group I) and seven patients with comatose or stuporous mentality who did not meet the clinical criteria of brain death (group II) were retrospectively reviewed. RESULTS Tonsilar herniation and loss of intraarterial flow signal voids (LIFSV) on T2WI were highly sensitive and specific findings for the diagnosis of brain death (p < 0.001 and < 0.001, respectively). DWI, TOF-MRA, and GRE findings were statistically different between the two groups (p = 0.015, 0.029, and 0.003, respectively). However, cortical high signal intensities in T2WI and SWI findings were not statistically different between the two group (p = 0.412 and 1.0, respectively). CONCLUSION T2-weighted imaging, DWI, and MRA using 3T MRI may be useful for diagnosing brain death. However, SWI findings are not specific due to high false positive findings.
Collapse
Affiliation(s)
- Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Lövblad KO, Haller S, Pereira VM. Stroke: high-field magnetic resonance imaging. Neuroimaging Clin N Am 2012; 22:191-205, x. [PMID: 22548928 DOI: 10.1016/j.nic.2012.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diagnostic modalities for the diagnosis of acute stroke have increased in number and quality. Magnetic resonance imaging has increasingly become a central tool for the management of patients with stroke. New sequences, such as diffusion and perfusion, provide insight into the infarcted core and the hypoperfused brain. The use of higher magnetic fields allows us to gain in signal strength, which can be used to improve imaging speed and/or resolution. Recent additional sequences allow perfusion without contrast and susceptibility-weighted imaging can help identify early bleeding. These new techniques should provide more information about the on going ischemic process.
Collapse
Affiliation(s)
- Karl-Olof Lövblad
- Division of Neuroradiology, Department of Imaging and Medical Informatics, Geneva University Hospitals HUG, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | | | | |
Collapse
|
37
|
Clinical applications of susceptibility weighted imaging in patients with major stroke. J Neurol 2011; 259:1426-32. [PMID: 22186853 DOI: 10.1007/s00415-011-6369-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/08/2011] [Indexed: 12/21/2022]
Abstract
Susceptibility weighted imaging (SWI) is a newly developed magnetic resonance (MR) protocol. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the susceptibility vessel sign (SVS). Some authors have even suggested that SWI can be used to predict outcome. We conducted a prospective study of patients hospitalized with middle cerebral artery territory infarction receiving MRI within 2 days of stroke onset. The presence of prominent veins, microbleeds and SVS in SWI was analyzed along with hospital characteristics of the patients. A total of 44 patients were enrolled. Among the 44 patients, 15 (34.1%) patients showed prominent veins, 19 (43.2%) showed SVS, and 14 (31.8%) showed microbleeds. The presence of SVS and prominent veins was not associated with prognosis. Though not statistically significant (p = 0.06), patients with SVS were more likely to develop later brain edema. SVS was significantly associated with arterial occlusion (p = 0.008) based on the MR angiogram, and microbleeds were significantly associated with later hemorrhagic transformation (p = 0.018). In our study, SWI could not be used to predict outcome as previously suggested. However, the presence of microbleeds may predict further hemorrhagic transformation, and the presence of SVS could be used to detect intra-arterial thrombus. Patients with SVS were also more likely to develop later brain edema. Including SWI in routine MR protocols for major acute ischemic stroke would be worthwhile.
Collapse
|
38
|
Rosso C, Belleville M, Pires C, Dormont D, Crozier S, Chiras J, Samson Y, Bonneville F. Clinical usefulness of the visibility of the transcerebral veins at 3T on T2*-weighted sequence in acute stroke patients. Eur J Radiol 2011; 81:1282-7. [PMID: 21444172 DOI: 10.1016/j.ejrad.2011.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/04/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of this work was to investigate the clinical usefulness of the visibility of the transcerebral veins (VTV) in acute ischemic stroke patients at 3T. METHODS Sixty consecutive carotid artery territory stroke patients were included retrospectively. Two readers categorized the VTV on T2*-weighted sequence at 3T for each hemisphere, and asymmetry of this sign was assessed between each hemisphere by an asymmetry index (AI) using a three-item scale. The VTV and AI were correlated with clinical and radiological covariates. Particular interest was focused on patients for whom initial diffusion-weighted imaging alone was inconclusive. RESULTS VTV were detected in the stroke hemisphere in 58.3% (n = 35) and in the contralateral side in 10% (n = 6, p<0.0001). Asymmetry of the VTV between ischemic and contralateral hemispheres was present in 53.3% (n = 32). Intracranial artery occlusion, final infarct volume and symptomatic hemorrhagic transformation were correlated with a higher AI at baseline (ρ = 0.563, ρ = 0.291, and ρ = 0.285, p<0.05, respectively). Three hyperacute stroke patients with subtle DWI high signal intensity at admission demonstrated VTV. CONCLUSIONS The pathological value of the VTV seems to reside in its asymmetry between hemispheres, as it was correlated with important clinical parameters. This study also suggests that the VTV could be a supportive finding in stroke diagnosis, especially when DWI is unreliable.
Collapse
Affiliation(s)
- Charlotte Rosso
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013 Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Tsai FY, Kao HW, Tsui YK, Hasso A, Greensite F. Susceptibility Weighted Imaging and Cerebrovascular Disorders. Neuroradiol J 2011; 24:121-7. [DOI: 10.1177/197140091102400117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/17/2022] Open
Abstract
To investigate the correlation between the SWI findings and prognosis of the cerebrovascular disorders. From July 2008 to July 2010, 299 ischemic stroke patients were found in our hospital. The gender ratio is as male and female being 157 to 142. The mean age of all patients is 65.4, mean female age is 69.1, and mean male age is 62.6. There were 86 patients who had satisfactory pre-and post-treatment of CT, MRI with SWI. 23 of these 86 patients had catheter cerebral angiography. 50 of these 86 patients had MR angiogram or CT angiogram. 13 of these 86 patients did not have angiogram. We have also collected 7 severe cardiac arrested and cessation of cerebral circulation and 2 patients with chronic venous hypertension. Among the 86 patients, 23 patients who had negative with deoxygenated vessel on SWI were with small infarction on DWI Thirty-one patients had negative on initial CT head scan. CT finding did not accord with presence of hypointense vessel on SWI. Sixty-three patients had varied degree of abnormal hypointense vessels on SWI as deoxygenated vessels. The initial small foci on DWI may result with a larger infarction if there were with prominent hypointense vessels.
Collapse
Affiliation(s)
- Fong Y Tsai
- Department of Radiology, UC Irvine Medical Center; Orange, CA, USA
| | - Hung-Wen Kao
- Department of Radiology, UC Irvine Medical Center; Orange, CA, USA
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center; Taipei, Taiwan
| | - Yu-Kun Tsui
- Department of Radiology, Chi-Mei Medical Center; Tainan, Taiwan
| | - A.N. Hasso
- Department of Radiology, UC Irvine Medical Center; Orange, CA, USA
| | - Fred Greensite
- Department of Radiology, UC Irvine Medical Center; Orange, CA, USA
| |
Collapse
|
40
|
Susceptibility-weighted imaging for differential diagnosis of cerebral vascular pathology: A pictorial review. J Neurol Sci 2009; 287:7-16. [PMID: 19772973 DOI: 10.1016/j.jns.2009.08.064] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 08/26/2009] [Accepted: 08/28/2009] [Indexed: 01/20/2023]
|
41
|
Bang OY. Multimodal MRI for ischemic stroke: from acute therapy to preventive strategies. J Clin Neurol 2009; 5:107-19. [PMID: 19826561 PMCID: PMC2760715 DOI: 10.3988/jcn.2009.5.3.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/17/2009] [Accepted: 07/17/2009] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose Conventional therapies for ischemic stroke include thrombolytic therapy, prevention of inappropriate coagulation and thrombosis, and surgery to repair vascular abnormalities. Over 10 years have passed since the US Food and Drug Administration approved intravenous tissue plasminogen activator for use in acute stroke patients, but most major clinical trials have failed during the last 2 decades, including large clinical trials for secondary prevention and neuroprotection. These results suggest the presence of heterogeneity among stroke patients. Neuroimaging techniques now allow changes to be observed in patients from the acute to the recovery phase. The role of MRI in stroke evaluation and treatment is discussed herein. Main Contents Three MRI strategies are discussed with relevant examples. First, the following MRI strategies for acute ischemic stroke are presented: diffusion-perfusion mismatch, deoxygenation (oxygen extraction and cerebral metabolic rate of oxygen), and blood-brain barrier permeability derangement in selected patients for recanalization therapy. Second, multimodal MRI for identifying stroke mechanisms and the specific causes of stroke (i.e., patent foramen ovale, infective endocarditis, and nonbacterial thrombotic endocarditis) are presented, followed by MRI strategies for prevention of recurrent stroke: plaque images and flow dynamics for carotid intervention. Expectations The studies reviewed herein suggest that using MRI to improve the understanding of individual pathophysiologies will further promote the development of rational stroke therapies tailored to the specifics of each case.
Collapse
Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Kaya D, Dinçer A, Yildiz ME, Cizmeli MO, Erzen C. Acute ischemic infarction defined by a region of multiple hypointense vessels on gradient-echo T2* MR imaging at 3T. AJNR Am J Neuroradiol 2009; 30:1227-32. [PMID: 19346312 DOI: 10.3174/ajnr.a1537] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE During the hyperacute phase of stroke, multiple hypointense vessels were identified specifically in the ischemic territory on gradient-echo T2*-weighted MR images (GRE-T2* WI) at 3T. The area was named a "region of multiple hypointense vessels (RMHV)." The aim of this study was to assess the usefulness of RMHV for the diagnosis of acute ischemic stroke (AIS) and to establish the relationship of this finding to other MR imaging studies. MATERIALS AND METHODS Twenty patients with AIS underwent MR imaging at 3T consisting of GRE-T2*, diffusion-weighted images (DWI), and perfusion-weighted images (PWI) within 6 hours of symptom onset and follow-up images at 72 hours. RMHV was defined as an area containing multiple hypointense vessels strictly in the region of the ischemic territory on GRE-T2*. The RMHV volume on GRE-T2*, initial ischemic lesion volumes on DWI, PWI maps, and on follow-up images were measured and compared with the RMHV volume. RESULTS RMHV on GRE-T2* was identified in 20 patients. There was no significant difference between the ischemic lesion volumes on mean transit time (247.3 +/- 88.1 mL), time-to-peak (228.6 +/- 88.8 mL), cerebral blood flow (200.6 +/- 89.7 mL), RMHV on GRE-T2* (214.4 +/- 86 mL), and the infarct volume at 72 hours (210.3 +/- 90.4 mL) (P = .975). CONCLUSIONS RMHV on GRE-T2* can be used as a supportive imaging finding for the diagnosis of hyperacute ischemic stroke. RMHV volume provides information that is in accordance with the infarct volume at 72 hours and the data supplied by PWI.
Collapse
Affiliation(s)
- D Kaya
- Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
43
|
Fushimi Y, Miki Y, Mori N, Okada T, Urayama SI, Fukuyama H, Togashi K. Signal Changes in the Brain on Susceptibility-Weighted Imaging Under Reduced Cerebral Blood Flow: A Preliminary Study. J Neuroimaging 2009; 20:255-9. [DOI: 10.1111/j.1552-6569.2008.00348.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
44
|
Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj K, Kapilamoorthy TR. Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol 2008; 64:74-83. [PMID: 19070701 DOI: 10.1016/j.crad.2008.04.022] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 04/17/2008] [Accepted: 04/29/2008] [Indexed: 01/05/2023]
Abstract
Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique that is exquisitely sensitive to paramagnetic substances, such as deoxygenated blood, blood products, iron, and calcium. This sequence allows detection of haemorrhage as early as 6h and can reliably detect acute intracerebral parenchymal, as well as subarachnoid haemorrhage. It detects early haemorrhagic transformation within an infarct and provides insight into the cerebral haemodynamics following stroke. It helps in the diagnosis of cerebral venous thrombosis. It also has applications in the work-up of stroke patients. The sequence helps in detecting microbleeds in various conditions, such as vasculitis, cerebral autosomal dominant arteriopathy, subacute infarcts and leucoencephalopathy (CADASIL), amyloid angiopathy, and Binswanger's disease. The sequence also aids in the diagnosis of vascular malformations and perinatal cerebrovascular injuries. This review briefly illustrates the utility of this MR technique in various aspects of stroke diagnosis and management.
Collapse
Affiliation(s)
- K Santhosh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | | | | | | | | | | |
Collapse
|
45
|
Mezzapesa DM, Petruzzellis M, Lucivero V, Prontera M, Tinelli A, Sancilio M, Carella A, Federico F. Multimodal MR examination in acute ischemic stroke. Neuroradiology 2006; 48:238-46. [PMID: 16508783 DOI: 10.1007/s00234-005-0045-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 10/06/2005] [Indexed: 12/11/2022]
Abstract
In recent years, combined diffusion-weighted imaging (DWI) with perfusion imaging (PI) has become an important investigational tool in the acute phase of ischemic stroke, as it may differentiate reversible from irreversible brain tissue damage. We consecutively examined 20 subjects within 12 h of stroke onset using a multiparametric magnetic resonance (MR) examination consisting of DWI, mean transit time (MTT) as PI parameter, and MR angiography (MRA). T2-weighted and fluid-attenuated inversion recovery (FLAIR) on day 7 were also acquired in order to obtain final infarct volume. The following MR parameters were considered: volumetric measures of lesion growth and MTT abnormalities, quantification of regional apparent diffusion coefficient (ADC) and visual inspection of MRA findings. Our results showed: (1) an acute DWI lesion was not predictive of lesion growth and the DWI abnormality did not represent the irreversibly infarcted tissue; (2) ADC values in the ischemic penumbra could not predict tissue at risk; (3) the DWI-PI mismatch did not predict lesion growth, and the PI abnormality overestimated the amount of tissue at risk; and (4) patients with proximal middle cerebral artery occlusion had greater initial and final infarct volumes. This study did not demonstrate the prognostic value of a multimodal MR approach in early ischemic stroke; MRA alone provided predictive information about the volumetric evolution of the lesion.
Collapse
Affiliation(s)
- D M Mezzapesa
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Hermier M, Nighoghossian N, Derex L, Wiart M, Nemoz C, Berthezène Y, Froment JC. Hypointense leptomeningeal vessels at T2*-weighted MRI in acute ischemic stroke. Neurology 2006; 65:652-3. [PMID: 16116143 DOI: 10.1212/01.wnl.0000173036.95976.46] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- M Hermier
- Department of Radiology, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Susceptibility-weighted (SW) MRI provides insight into the pathophysiology of acute stroke. We report on the use of SW imaging (SWI) sequences in clinical practice and highlight the future applications. SUMMARY OF REVIEW SWI exploits the magnetic susceptibility effects generated by local inhomogeneities of the magnetic field. The paramagnetic properties of deoxyhemoglobin support signal changes related to acute hemorrhage and the intravascular spontaneous blood oxygen level dependent (BOLD) effect. SWI allows the early detection of acute hemorrhage within 6 hours after symptom onset. SWI may also identify previous microbleeds in acute ischemia; however, the impact of these findings on thrombolytic therapy safety has not been definitely established. The diagnosis of arterial occlusion is usually performed by magnetic resonance angiography. SWI allows intravascular clot detection at the acute stage.Substantial experimental data suggest that spontaneous BOLD contrast may improve tissue viability assessment. The ratio of oxyhemoglobin to deoxyhemoglobin, measured by MRI in the capillary and venous compartments, reflects the oxygen extraction fraction (OEF) and the cerebral metabolic rate of oxygen. The combination of magnetic resonance (MR)-measured OEF and cerebral blood flow, via perfusion studies, may provide information about tissue viability. CONCLUSIONS SWI offers a spectrum of current clinical applications and may improve our knowledge of the pathophysiology of acute stroke.
Collapse
Affiliation(s)
- Marc Hermier
- Department of Neuroradiology and MRI, and the Cerebrovascular Disease Center, CREATIS, CNRS UMR 5515, INSERM U630 Hôpital Neurologique P. Wertheimer, Claude-Bernard Lyon-I University, Lyon, France
| | | |
Collapse
|