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Wu G, Wang H, Ma X, Li H, Song B, Zhao J, Wang X, Lin J. SWI and CTP fusion model based on sparse representation method to predict cerebral infarction trend. Front Neurosci 2024; 18:1360459. [PMID: 38966761 PMCID: PMC11222412 DOI: 10.3389/fnins.2024.1360459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Objective SWI image signal is related to venous reflux disorder and perfusion defect. Computed tomography perfusion (CTP) contains perfusion information in space and time. There is a complementary basis between them to affect the prognosis of cerebral infarction. Methods Sixty-six patients included in the retrospective study were designated as the training set. Effective perfusion indicator features and imaging radiomic features of the peri-infarction area on Susceptibility weighted imaging (SWI) and CTP modality images were extracted from each case. Thirty-three patients from the prospectively included group were designated as the test set of the machine learning model based on a sparse representation method. The predicted results were compared with the DWI results of the patients' 7-10 days review to assess the validity and accuracy of the prediction. Results The AUC of the SWI + CTP integrated model was 0.952, the ACC was 0.909, the SEN was 0.889, and the SPE was 0.933. The prediction performance is the highest. Compared with the value of AUC: the SWI model is 0.874, inferior to the performance of the SWI + CTP model, and the CTP model is 0.715. Conclusion The prediction efficiency of the changing trend of infarction volume is further improved by the correlation between the combination of the two image features.
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Affiliation(s)
- Guoqing Wu
- Department of Electronic Engineering, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaojun Ma
- Department of Laboratory Medicine, Minhang Hospital, Fudan University, Shanghai, China
| | - Huanyin Li
- Department of Laboratory Medicine, Minhang Hospital, Fudan University, Shanghai, China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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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.
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Affiliation(s)
- Vi Tuan Hua
- Stroke Unit, Reims University Hospital, Reims, France
| | | | | | | | | | | | | | - Solène Moulin
- Stroke Unit, Reims University Hospital, Reims, France.
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Yang T, Peng P, Jiang S, Yan Y, Hu Y, Wang H, Ye C, Pan R, Sun J, Wu B. Multiple Hypointense Vessels are Associated with Cognitive Impairment in Patients with Single Subcortical Infarction. Transl Stroke Res 2023:10.1007/s12975-023-01206-9. [PMID: 38051469 DOI: 10.1007/s12975-023-01206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
We aimed to explore the relationship between multiple hypointense vessels and cognitive function in patients with single subcortical infarction (SSI) and the role of SSI with different etiological mechanisms in the above relationship. Multiple hypointense vessels were measured by the number of deep medullary veins (DMVs), DMVs score, and cortical veins (CVs) score. The Montreal Cognitive Assessment (MoCA), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) were assessed to evaluate cognitive function. SSI was dichotomized as branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI by whole-brain vessel-wall magnetic resonance imaging. We included a total of 103 acute SSI patients. After adjustments were made for related risk factors of cognitive function, the SSI patients with higher DMVs score were more likely to have longer STT-B (P = 0.001) and smaller STT-B-1 min (P = 0.014), and the SSI patients with higher CVs score were more likely to have shorter STT-A (P = 0.049). In subgroup analysis, we found that the negative relationship between DMVs scores and cognitive function and the positive relationship between CVs scores and cognitive function were significantly stronger in BAD patients. We provided valuable insights into the associations between DMVs, CVs, and multi-domain cognitive impairment in SSI patients, which underscored the necessity to further study the dynamic alterations of venules and their specific influence on post-stroke cognitive impairment.
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Affiliation(s)
- Tang Yang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Pengfei Peng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Yi Hu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ruosu Pan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
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Fu X, Ke J, Li J, Lv K, Chen J, Li J, Zheng W, Shi Z. Prominent Vessel Signs After Endovascular Thrombectomy Corelates with Unexplained Neurological Deterioration and is a More Reliable Imaging Predictor of Prognosis in Anterior Large Vessel Occlusion Stroke. World Neurosurg 2023; 179:e201-e211. [PMID: 37619843 DOI: 10.1016/j.wneu.2023.08.052] [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: 07/23/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Fifty percent of patients who undergo endovascular thrombectomy (EVT) for large-vessel occlusion exhibit unfavorable outcomes. The primary factor is attributed to persistent brain impairment even after successful EVT. The prominent vessel sign (PVS) on magnetic resonance susceptibility-weighted imaging reflects the territory of dysmetabolism and may facilitate an expeditious assessment for prognostication. We aimed to examine the relationship between PVS after EVT and the occurrence of early neurological deterioration (END) and 3-month outcomes. METHODS Patients who underwent EVT and multimodal magnetic resonance imaging were included. END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale within 72 hours after EVT. Symptomatic intracranial hemorrhage, malignant edema, and surgical complications were defined as definite END, whereas the other symptoms were categorized as unexplained END (ux-END). The PVS-Alberta Stroke Program Early CT Score (ASPECTS) score was used to evaluate the asymmetric cerebral venous signal on the susceptibility-weighted imaging sequences semiquantitatively. RESULTS A total of 116 eligible patients were included, 18 (15.5%) of whom presented with ux-END. The 72 hour National Institutes of Health Stroke Scale was strongly correlated with diffusion-weighted imaging infarct volume and PVS-ASPECTS and was significantly higher in the ux-END group (16 ± 6 vs. 5 ± 4, P = 0.001). The PVS-ASPECTS score was significantly associated with poor outcomes (odds ratio 2.551, 95% confidence interval (CI) 1.722-3.780, P<0.001), and PVS-ASPECTS (area under the curve 0.884, 95% CI 0.815-0.953, P < 0.001) was superior to diffusion-weighted imaging infarct volume (area under the cure 0.720, 95% CI 0.620-0.820, P = 0.001) in predicting 3-month poor outcome. At the optimal cut-off of 2, the PVS-ASPECT predicted poor outcomes with a sensitivity of 89.7% and a specificity of 78.2%. CONCLUSIONS PVS 72 hours after EVT correlated with ux-END. The PVS-ASPECTS is a more reliable predictor of stroke prognosis and provides valuable information regarding post-EVT management.
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Affiliation(s)
- Xiaoli Fu
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Jianxia Ke
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Jintao Li
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Kefeng Lv
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Junting Chen
- Postgraduate School, Guangdong Medical University, Zhanjiang, China
| | - Jinrui Li
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Weicheng Zheng
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Zhu Shi
- Department of Neurology and Stroke Center, Affiliate Dongguan People's Hospital, Southern Medical University, Dongguan, China; Postgraduate School, Guangdong Medical University, Zhanjiang, China.
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Xiang W, Wei H, Liang Z, Zhang M, Sun Z, Lv Y, Zhang C, Zheng H. FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome. Eur J Med Res 2023; 28:446. [PMID: 37853442 PMCID: PMC10585931 DOI: 10.1186/s40001-023-01445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND To investigate the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH) within asymmetrical prominent veins sign (APVS) on susceptibility-weighted imaging predicting collateral circulation and prognosis in patients with acute anterior circulation ischemic stroke. METHOD Patients with severe stenosis or occlusion of ICA or MCA M1, who underwent MRI within 72 h from stroke onset were reviewed. The Alberta Stroke Program Early CT Score was used to evaluate the volume of infarction on DWI, the degree of FVH and APVS. Spearman correlation analysis was used to evaluate the correlation between FVH and APVS. All patients were divided into the good prognosis group and the poor prognosis group according to the score of the modified ranking scale (mRS) 90 days after the stroke. Logistic regression analysis was used to explore the relationship between FVH and APVS and functional prognosis, while receiver operating characteristic (ROC) curves were plotted to assess the value of FVH and APVS in predicting prognosis. RESULTS Spearman correlation analysis revealed moderate positive correlations between FVH and APVS (r = 0.586, P < 0.001). The poor prognosis group had a higher rate of a history of atrial fibrillation, a larger cerebral infarction volume, a higher NIHSS score at admission, and a higher FVH and APVS score compared with the good prognosis group (all P < 0.05). A further logistic regression indicated that the NIHSS score, cerebral infarction volume, FVH and APVS were independent risk factors for a poor functional prognosis. In terms of FVH, APVS, alone and their combination for the diagnosis of poor prognosis, the sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (CI) were 86.8%, 83.3%, 0.899 (95% CI 0.830-0.968); 60.5%, 93.7%, 0.818 (95% CI 0.723-0.912); 86.8%, 89.6%, 0.921 (95% CI 0.860-0.981), respectively. CONCLUSION The presence of FVH and APVS can provide a comprehensive assessment of collateral circulation from the perspective of veins and arteries, and the correlation between the two is positively correlated. Both of them were independent risk factors for poor prognosis, their combination is complementary and can improve the predictive value.
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Affiliation(s)
- Wei Xiang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Hongchun Wei
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Zhigang Liang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China.
| | - Manman Zhang
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Zhongwen Sun
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Yaodong Lv
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Chengzhou Zhang
- Department of Radiology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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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.
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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
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Xiang W, Liang Z, Zhang M, Wei H, Sun Z, Lv Y, Meng Y, Li W, Zheng H, Zhang H. Prognostic value of susceptibility-weighted imaging of prominent veins in acute ischemic stroke: A systematic review and meta-analysis. Front Neurol 2022; 13:1052035. [DOI: 10.3389/fneur.2022.1052035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
BackgroundThe prominent veins sign (PVS) on susceptibility-weighted imaging (SWI) has been suggested to be related to the prognosis of patients with acute ischemic stroke (AIS). This meta-analysis aims to clarify the association between PVS and the prognosis of patients with AIS.MethodsThis meta-analysis was registered in PROSPERO (no. CRD42022343795). We performed systematic research in PubMed, Web of Science, EMBASE, and Cochrane Library databases for studies investigating the prognostic value of PVS. Based on the enrolled studies, patients were divided into two groups as follows: those with PVS cohort and those without PVS cohort. Outcomes were unfavorable functional outcome, early neurological deterioration (END), and hemorrhagic transformation (HT). The random-effects models were used for the meta-analytical pooled. Heterogeneity was estimated using Cochran's Q-test and I2 value. Subgroup and sensitivity analyses were also performed to explore the potential sources of heterogeneity. Publication bias was assessed with funnel plots and using Begger's and Egger's tests.ResultsA total of 19 studies with 1,867 patients were included. PVS was correlated with an unfavorable functional outcome in patients with AIS (risk ratio [RR] 1.61, 95% CI 1.28–2.02), especially in those receiving recanalization therapy (RR 2.00, 95% CI 1.52–2.63), but not in those treated conservatively (RR 1.33, 95% CI 0.87–2.04). Moreover, PVS was related to END (RR 2.77, 95% CI 2.21–3.46), while without an increased risk of HT (RR 0.97, 95% CI 0.64–1.47).ConclusionPVS was associated with an unfavorable prognosis of patients with AIS and increased the risk of END, while not correlated with an increased risk of HT. PVS might be useful for predicting functional outcomes of patients with AIS as a novel imaging maker.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022343795.
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Association between Deep Medullary Veins in the Unaffected Hemisphere and Functional Outcome in Acute Cardioembolic Stroke: An Observational Retrospective Study. Brain Sci 2022; 12:brainsci12080978. [PMID: 35892419 PMCID: PMC9330894 DOI: 10.3390/brainsci12080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: To explore whether deep medullary veins (DMVs) in the unaffected hemisphere were associated with functional outcome in acute cardioembolic stroke patients. Methods: Acute cardioembolic stroke patients at a single center were retrospectively included. DMVs visibility in the unaffected hemisphere was assessed using a well-established four-grade scoring method based on susceptibility-weighted imaging (SWI): grades 0−3 (grade 0 for no visible DMVs; grade 1 for the numbers of conspicuous DMVs < 5; grade 2 for numbers raging from 5 to 10; grade 3 for more than 10). Patients were further divided into mild-to-moderate (grade 0−2) and severe DMVs (grade 3) groups. Functional outcomes were evaluated using the modified Rankin scale (mRS) score at three months. Poor outcome was defined as mRS ≥ 3. Binary logistic regression analysis was used to explore the association between DMVs grade and functional outcome. Results: A total of 170 patients were finally included. Compared with the mild-to-moderate DMVs group (149 patients), the severe DMVs group (21 patients) had higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.002), lower levels of admission systolic blood pressure (BP) (p = 0.031), and elevated rates of large infarction (p = 0.003). At three months, the severe DMVs group had higher mRS (p = 0.002). Patients in the poor outcome group (82/170, 48.2%) had older age, higher baseline NIHSS score, lower admission diastolic BP, higher rates of hemorrhagic transformation and large infarction, and an increased proportion of severe DMVs (all p < 0.05). After adjusting for confounders, multivariable regression analysis showed that the severe DMVs grade (adjusted odds ratio [OR] = 5.830, 95% confidence interval [CI] = 1.266−26.856, p = 0.024) was significantly associated with three-month functional outcomes without interaction with other potential risk factors (p for interaction > 0.05). Conclusions: DMVs grade in the unaffected hemisphere was independently associated with three-month functional outcome in acute cardioembolic stroke patients. Patients with severe DMVs were more likely to have a poor functional outcome at three months.
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Application of susceptibility weighted imaging (SWI) in diagnostic imaging of brain pathologies – a practical approach. Clin Neurol Neurosurg 2022; 221:107368. [DOI: 10.1016/j.clineuro.2022.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
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Del Poggio A, Godi C, Calloni SF, Ragusi M, Iadanza A, Falini A, Anzalone N. Multiple hypointense veins on susceptibility weighted imaging as a promising biomarker of impaired cerebral hemodynamics in chronic steno-occlusive disease: a multiparametric MRI study. Neuroradiology 2022; 64:2235-2243. [PMID: 35699773 DOI: 10.1007/s00234-022-02994-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with steno-occlusive arterial disease may develop cerebral hypoperfusion with possible neurologic sequelae. The aim of the study is to verify the possible role of SWI, as a marker of cerebral hypoperfusion, in the identification of patient subgroups with significant chronic occlusions/stenoses at risk of critical cerebral hypoperfusion. METHODS We retrospectively identified 37 asymptomatic patients with chronic intra-extracranial occlusion/stenosis of the anterior circulation from a prospective brain MRI register between 2016 and 2020. All patients underwent 3 Tesla MRI. The imaging protocol included the following: SWI, 3D-FLAIR, DWI sequences, and 3D-TOF MRA. SWI findings were graded for the presence of asymmetric intracranial cortical veins (grades 1 to 4). The presence of collateralization was assessed with concomitant multiphase-CTA. FLAIR was evaluated for the presence of distal hyperintense vessels (DHVs), a described marker of flow impairment, and possible collateralization. Cerebral blood flow and arterial transit artifacts (ATAs) were evaluated at pCASL in 29 patients. RESULTS SWI showed multiple hypointense vessels (MHVs) in 22/37 patients in the cerebral hemisphere ipsilateral to vessel occlusion/stenosis. SWI-MHV grade 1 was found in 15 patients (40.5%), grade 2 in 18 patients (48.7%), and grade 3 in 3 patients (8.1%); in one patient, SWI was graded as 4 (2.7%). A significant relationship was found among MHV, DHV, collaterals, ATAs, and hypoperfused areas on pCASL and with patients' previous neurological symptoms. CONCLUSION SWI-MVH correlates with chronic cerebral flow impairment and is related to hypoperfusion and collateralization. It may help identify a subgroup of patients benefitting from revascularization.
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Affiliation(s)
- Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
| | - Claudia Godi
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Sonia Francesca Calloni
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Maria Ragusi
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Antonella Iadanza
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.,San Raffaele Vita-Salute University, Milan, Italy
| | - Nicoletta Anzalone
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, Via Olgettina 60, Milan, Italy.,San Raffaele Vita-Salute University, Milan, Italy
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11
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Hirtz C, Adam G, Raposo N, Fabre N, Ducros A, Calviere L, Rousseau V, Albucher JF, Olivot JM, Bonneville F, Viguier A. Diagnostic utility of T2*-weighted GRE in migraine with aura attack. The cortical veins sign. Cephalalgia 2022; 42:730-738. [PMID: 35301873 DOI: 10.1177/03331024221076484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the frequency, distribution, and clinical associations of the dilated appearance of cerebral cortical veins, termed cortical veins sign on T2*-weighted gradient recalled-echo (T2*-GRE) in the acute setting of migraine with aura attack in adult patients. METHODS We conducted a retrospective analysis of 60 consecutive patients admitted for acute neurological symptoms with a final diagnosis of migraine with aura (42%) or probable migraine with aura (58%) who underwent emergency brain magnetic resonance imaging and 60 non-migrainous control adults. The cortical veins sign was defined as a marked hypo-intensity and/or an apparent increased diameter of at least one cortical vein. We examined the prevalence, the spatial distribution, and the associations of cortical veins sign with clinical characteristics of migraine with aura. RESULTS We detected the cortical veins sign in 25 patients (42%) with migraine with aura, compared to none in the control group (p < 0.0001). The spatial distribution of cortical veins sign was characterised by the predominantly bilateral and posterior location. Presence of cortical veins sign was associated with increased severity of aura (p = 0.05), and shorter delay to MRI (p = 0.02). CONCLUSION In the setting of acute neurological symptoms, the presence of cortical veins sign is frequent in patients with migraine with aura and can be detected with good reliability. This imaging marker may help clinicians identify underlying migraine with aura.
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Affiliation(s)
- Chloe Hirtz
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Gilles Adam
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Nelly Fabre
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Lionel Calviere
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Vanessa Rousseau
- Department of Pharmacovigilence and Pharmaco-epidemiology, Toulouse University, Toulouse, France
| | - Jean François Albucher
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Jean-Marc Olivot
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Alain Viguier
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
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12
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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: 1] [Impact Index Per Article: 0.5] [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.
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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
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13
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Oh M, Lee M. Clinical Implications of Prominent Cortical Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke Patients Treated with Recanalization Therapy. Brain Sci 2022; 12:brainsci12020184. [PMID: 35203945 PMCID: PMC8869791 DOI: 10.3390/brainsci12020184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Prominent cortical vessels on susceptibility-weighted imaging (PCV–SWI) correlate with poor leptomeningeal collaterals. However, little is known about PCV–SWI in recanalization therapy-treated patients with anterior circulation large vessel occlusions (LVO). We investigated PCV–SWI-based assessment of leptomeningeal collaterals and outcome predictions in 100 such patients in an observational study. We assessed PCV–SWI using the Alberta Stroke Program Early CT Score and evaluated leptomeningeal collaterals on multiphase CT angiography (mCTA). Predictive abilities were analyzed using multivariable logistic regression and area of receiver operating curves (AUCs). The extent of PCV–SWI correlated with leptomeningeal collaterals on mCTA (Spearman test, r = 0.77; p < 0.001); their presence was associated with worse functional outcomes and a lower successful recanalization rate (adjusted odds ratios = 0.24 and 0.23, 95% CIs = 0.08–0.65 and 0.08–0.65, respectively). The presence of PCV–SWI predicted outcomes better than good collaterals on mCTA did (C-statistic = 0.84 vs. 0.80; 3-month modified Rankin Scale (mRS) 0–2 = 0.75 vs. 0.67 for successful recanalization). Comparison of AUCs showed that they had similar abilities for predicting outcomes (p = 0.68 for 3-month mRS 0–2; p = 0.23 for successful recanalization). These results suggest that PCV–SWI is a useful feature for assessing leptomeningeal collaterals in acute ischemic stroke patients with anterior circulation LVO and predicting outcomes after recanalization therapy.
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14
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Yang L, Yu L, Qin W, Li Y, Yang S, Li X, Hu W. The Influence of Cerebral Arterial Circle on Prominent Hypointense Vessel Signs in Patients With Internal Carotid Artery Occlusion. Front Neurol 2022; 12:753877. [PMID: 35095716 PMCID: PMC8794947 DOI: 10.3389/fneur.2021.753877] [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: 08/17/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background and PurposePrevious studies on the presence of asymmetrical prominent cortical and medullary vessel signs (APCV/APMV) and collateral circulation in patients with internal carotid artery occlusion internal carotid artery occlusion (ICAO) are rare, and the conclusions are inconsistent. Our study aimed to investigate the relationship between the presence of APCV/APMV and collateral circulation in patients with ICAO.MethodsPatients with acute ischemic stroke with ICAO were recruited in this study. All 74 patients were divided into two groups depending on the presence of APCV and APMV. The status of the cerebral arterial circle (CAC) was graded as poor or good. The poor CAC was defined as MCA was invisible. Severe stroke was defined as cerebral watershed infarction (CWI) or territorial infarction (TI). Clinical and radiological markers were compared between these two groups. Logistic regression was used to investigate the association between the APCV/APMV and clinical and radiological markers.ResultsA total of 74 patients with ICAO were enrolled. Forty-three patients (58.1%) presented with an APCV and APMV was found in 35 (47.2%) patients. Compared with patients with non-APCV, patients with APCV had a more severe stroke (P = 0.038) and had a significantly higher incidence of poor CAC (P = 0.022) than those with APCV. Patients with APMV had a more severe stroke (P = 0.001). Logistic regression showed that poor CAC was independently associated with APCV and severe stroke were independently associated with APMV.ConclusionsOur study demonstrates that poor CAC was independently associated with the presence of the APCV in patients with ICAO. Severe stroke was independently associated with the APMV.
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Affiliation(s)
- Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lei Yang
| | - Ling Yu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuanting Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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15
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Li Z, Bai X, Gao P, Lin Y, Ju Y, Sui B. Changes of prominent vessel sign and susceptibility vessel sign in acute ischemic stroke patients with and without successful recanalization: a study based on susceptibility weighted images. Neurol Res 2022; 44:583-590. [PMID: 35001834 DOI: 10.1080/01616412.2021.2024729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the changes of prominent vessel sign (PVS) and susceptibility vessel sign (SVS) in acute ischemic stroke (AIS) patients with successful and non-successful vascular recanalization treatment, and to study the associations between the susceptibility-weighted imaging (SWI) findings and early clinical and imaging prognosis. METHODS Thirty-five patients with the acute MCA territory infarction were retrospectively included and classified into Groupre (n = 25) and Groupnon (n = 10) according to the success of vascular recanalization. NIHSS was used for clinical assessment. PVS and DWI were analyzed using ASPECT scores. Baseline, post-treatment, the changes of PVS and SVS, and SVS length were recorded and compared between two groups. Correlation analysis was performed between SWI factors and early post-treatment clinical and imaging factors. RESULTS The mean PVSpre value was 5.20 ± 1.76 and PVSpost was 8.20 ± 1.86. PVSpre and PVSpost showed statistical significance between Groupre and Groupnon (both p < 0.001). A significant difference wasfound in SVSpost(+) (p < 0.001), SVSpost-pre(+) (p = 0.001), SVSpost-pre length (p = 0.036) and SVSpost length (p = 0.001) between the two groups. A positive correlation was found between PVSpre and DWIpost (p < 0.001, r = 0.564). There were positive correlations between PVS-DWI mismatch and NIHSSpost in Groupre (p = 0.042, r = 0.410) and in Groupnon (p = 0.006, r = 0.789). CONCLUSIONS PVS and SVS changes are influenced by the success of vascular recanalization. However, the changes are unrelated to either early clinical or imaging outcomes in AIS patients. PVS-DWI mismatch can be taken as an imaging biomarker for early clinical outcomes, both for patients with or without successful vascular recanalization.
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Affiliation(s)
- Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Yan Lin
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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16
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Collateral estimation by susceptibility-weighted imaging and prediction of functional outcomes after acute anterior circulation ischemic stroke. Sci Rep 2021; 11:21370. [PMID: 34725373 PMCID: PMC8560757 DOI: 10.1038/s41598-021-00775-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/14/2021] [Indexed: 12/14/2022] Open
Abstract
To determine the value of susceptibility-weighted imaging (SWI) for collateral estimation and for predicting functional outcomes after acute ischemic stroke. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, SWI collateral grade, mode of treatment, and successful reperfusion were evaluated by multiple logistic regression analyses. A total of 152 participants were evaluated. A younger age (adjusted odds ratio (aOR), 0.42; 95% confidence interval (CI) 0.34 to 0.77; P < 0.001), a lower baseline NIHSS score (aOR 0.90; 95% CI 0.82 to 0.98; P = 0.02), a smaller baseline DWI lesion volume (aOR 0.83; 95% CI 0.73 to 0.96; P = 0.01), an intermediate collateral grade (aOR 9.49; 95% CI 1.36 to 66.38; P = 0.02), a good collateral grade (aOR 6.22; 95% CI 1.16 to 33.24; P = 0.03), and successful reperfusion (aOR 5.84; 95% CI 2.08 to 16.42; P = 0.001) were independently associated with a favorable functional outcome. There was a linear association between the SWI collateral grades and functional outcome (P = 0.008). Collateral estimation using the prominent vessel sign on SWI is clinically reliable, as it has prognostic value.
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17
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Zhan YH, Chen YK, Li RX, Luo GP, Wu ZQ, Liu YL, Xiao WM, Hu WD, Xie CQ. Cortical Venous Changes on Susceptibility-Weighted Imaging Predict the Cerebral Collateral Circulation as Confirmed by Digital Subtraction Angiography. Front Neurol 2021; 12:691430. [PMID: 34512512 PMCID: PMC8430322 DOI: 10.3389/fneur.2021.691430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Asymmetrical cortical vein sign (ACVS) shown on susceptibility-weighted imaging (SWI) can reflect regional hypoperfusion. We investigated if ACVS could predict the cerebral collateral circulation (CC) as assessed by digital subtraction angiography (DSA) in acute ischemic stroke patients with ipsilateral severe stenosis/occlusion of the anterior circulation. Methods: Clinical data and imaging data of 62 acute ischemic stroke patients with ipsilateral severe stenosis or occlusion of the anterior circulation confirmed by DSA were collected retrospectively. Participants underwent magnetic resonance imaging, including an SWI sequence. ACVS was defined as more and/or larger venous signals in the cerebral cortex of one side of SWI than that in the contralateral side. ACVS was measured using the Alberta Stroke Program Early Computed Tomography score based on SWI. The grading of the cerebral CC was judged using DSA. Results: Of the 62 patients, 30 patients (48.4%) had moderate-to-severe ACVS. According to DSA assessment, 19 patients (30.6%) had a good CC (grade 3–4), and 43 (69.4%) patients had a poor-to-moderate CC (grade 0–2). Among the 30 patients with moderate-to-severe ACVS, only three (10%) patients had a good CC, and 27 (90%) patients had a poor-to-moderate CC; among the 32 patients with none or mild ACVS, 16 (50%) of them had a good CC, and the other 50% had a moderate-to-severe CC. We constructed two logistic regression models with ACVS grading and none or mild ACVS entered into the models, respectively, together with age and large-artery occlusion. In model 1, no ACVS (compared with severe ACVS; OR = 40.329, 95%CI = 2.817–577.422, P = 0.006), mild ACVS (compared with severe ACVS; OR = 17.186, 1.735–170.224, 0.015) and large-artery occlusion (OR = 45.645, 4.603–452.592, 0.001) correlated with a good CC. In model 2, none or mild ACVS (OR = 36.848, 95%CI = 5.516–246.171, P < 0.001) was significantly associated with a good CC as judged by DSA, adjusted by age and large-artery occlusion. Conclusions: Cortical venous changes in SWI may be a useful indicator for the cerebral CC as confirmed by DSA.
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Affiliation(s)
- Yun-Hao Zhan
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Run-Xiong Li
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Gen-Pei Luo
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Zhi-Qiang Wu
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Yong-Lin Liu
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Wei-Dong Hu
- Department of Neurology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
| | - Cai-Qin Xie
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
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18
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Jiang H, Zhang Y, Pang J, Shi C, Liu AF, Li C, Jin M, Man F, Jiang WJ. Susceptibility-diffusion mismatch correlated with leptomeningeal collateralization in large vessel occlusion stroke. J Int Med Res 2021; 49:3000605211013179. [PMID: 34038211 PMCID: PMC8161861 DOI: 10.1177/03000605211013179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the relationship between asymmetric prominent hypointense vessels (prominent vessel sign, PVS) on susceptibility-weighted imaging (SWI) and leptomeningeal collateralization in patients with acute ischemic stroke due to large vessel occlusion. Methods We retrospectively enrolled patients with M1 segment occlusion of the middle cerebral artery who underwent emergency magnetic resonance imaging and digital subtraction angiography within 24 hours from stroke onset. The extent of PVS on SWI was assessed using the Alberta Stroke Program Early CT Score (ASPECTS). Leptomeningeal collateralization on digital subtraction angiography images was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Spearman’s rank correlation test was performed to explore the correlation of ASITN/SIR scores with SWI-ASPECTS and SWI-diffusion-weighted imaging (DWI) mismatch scores. Results Thirty-five patients were enrolled. There was no significant correlation between SWI-ASPECTS and ASITN/SIR scores. However, SWI-DWI mismatch scores were positively correlated with ASITN/SIR scores. Conclusion The range of PVS on SWI did not closely reflect the collateral status, while the range of SWI-DWI mismatch was significantly correlated with the leptomeningeal collateralization. In patients with acute anterior circulation stroke due to large vessel occlusion, larger SWI-DWI mismatch was associated with better leptomeningeal collaterals.
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Affiliation(s)
- Haifei Jiang
- Medical College of Soochow University, Suzhou, China.,Stroke Center, Tongzhou People's Hospital, Nantong, China
| | - Yiqun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jiangxia Pang
- Medical College of Soochow University, Suzhou, China
| | - Chaojie Shi
- Stroke Center, Tongzhou People's Hospital, Nantong, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Fengyuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, China.,New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
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Jiang HF, Zhang YQ, Pang JX, Shao PN, Qiu HC, Liu AF, Li C, Jin M, Man FY, Jiang WJ. Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke. Sci Rep 2021; 11:5641. [PMID: 33707446 PMCID: PMC7952411 DOI: 10.1038/s41598-021-84269-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.
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Affiliation(s)
- Hai-Fei Jiang
- Medical College of Soochow University, Suzhou, 215123, China.,Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Yi-Qun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Jiang-Xia Pang
- Medical College of Soochow University, Suzhou, 215123, China
| | - Pei-Ning Shao
- Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Han-Cheng Qiu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Feng-Yuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, 215123, China. .,New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China.
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20
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Jing L, Sui B, Shen M, Qin H, Gao P. Are prominent medullary veins better than prominent cortical veins as predictors of early clinical outcome in patients with acute ischemic stroke? Diagn Interv Radiol 2021; 27:285-292. [PMID: 33517255 DOI: 10.5152/dir.2021.19644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. METHODS Forty-seven consecutive patients with AIS within the middle cerebral artery territory were recruited. Magnetic resonance imaging was performed within 8 hours of symptom onset and at 7 days after stroke onset. Infarct volume was measured, and the early clinical outcome at 7 days was assessed using the modified Rankin Scale. PVS was dichotomized into cases with both PCV and PMV and cases with only PCV according to location. RESULTS Patients with both PCV and PMV (n=32) had higher admission National Institutes of Health Stroke Scale scores (p = 0.020), larger infarct volumes at baseline (p = 0.026) and 7 days (p = 0.007), and larger infarct growth at 7 days (p = 0.050) than those with PCV only. Multivariate regression analysis showed that both the time of onset at baseline (p = 0.013) and infarct growth at 7 days (p = 0.014) could independently predict poor early clinical outcome. CONCLUSION PMV may predict poor early clinical outcome in AIS patients, and reperfusion therapy may, therefore, be required more urgently in patients with PMV.
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Affiliation(s)
- Lina Jing
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | | | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China;Beijing Neurosurgical Institute, Beijing, China
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21
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Li W, Xiao WM, Luo GP, Liu YL, Qu JF, Fang XW, Wang F, Chen YK. Asymmetrical cortical vein sign predicts early neurological deterioration in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion. BMC Neurol 2020; 20:331. [PMID: 32878608 PMCID: PMC7466490 DOI: 10.1186/s12883-020-01907-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). Methods One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Results Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580–11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume. Conclusions In acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.
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Affiliation(s)
- Wei Li
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China
| | - Gen-Pei Luo
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China
| | - Xue-Wen Fang
- Department of Radiology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong Province, China
| | - Fang Wang
- Department of Radiology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong Province, China
| | - Yang-Kun Chen
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University, Wandao Road South No.3, Wanjiang District, Dongguan, Guangdong Province, China.
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22
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Wang C, Xian L, Chen X, Li Z, Fang Y, Xu W, Wei L, Chen W, Wang S. Visualization of cortical cerebral blood flow dynamics during craniotomy in acute subdural hematoma using laser speckle imaging in a rat model. Brain Res 2020; 1742:146901. [PMID: 32445715 DOI: 10.1016/j.brainres.2020.146901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
Mass evacuation with decompressive craniotomy is considered a standard intervention for acute subdural hematoma (ASDH). However, hemispheric swelling complicates the intraoperative and postoperative management of ASDH patients, and previous studies have revealed that this approach can damage ischemic/reperfusion (I/R) injury. Few studies have focused on the cerebrovascular response following traumatic brain injury (TBI). To characterize the relative cerebral blood flow (rCBF) before and after removal of the hematoma, rats were injured by a subdural infusion of 400 μL of venous blood or paraffin oil. MRI scans were performed. Then, we monitored cortical rCBF during hematoma removal in real time using laser speckle imaging (LSCI) in ASDH rats. The CBF of arteriovenous and capillary regions were quantified and normalized to their own baseline values via a custom algorithm. In the sham group, the cortical CBF was higher post-craniotomy than pre-craniotomy. However, in the hematoma injection group, the CBF of arteries and capillaries was higher while the venous CBF was lower post-craniotomy than pre-craniotomy. The difference in the changes in vein CBF that occurred between the two groups was statistically significant. The three components of the vascular system showed heterogeneous responses to craniotomy, which may be the basis for secondary brain injury.
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Affiliation(s)
- Cheng Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Liang Xian
- Bengbu Medical College, Bengbu, Anhui, PR China
| | - Xiangrong Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, PR China
| | - Zuanfang Li
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China
| | - Yi Fang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Weiming Xu
- Department of Neurosurgery, The Hospital of Changle, Fuzhou, PR China
| | - Liangfeng Wei
- Department of Neurosurgery, 900th Hospital, Fuzhou, PR China
| | - Weiqiang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, PR China
| | - Shousen Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China; Department of Neurosurgery, 900th Hospital, Fuzhou, PR China.
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23
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Liu YL, Yin HP, Qiu DH, Qu JF, Zhong HH, Lu ZH, Wang F, Liang MQ, Chen YK. Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis. Stroke Vasc Neurol 2020; 5:361-367. [PMID: 32586972 PMCID: PMC7804053 DOI: 10.1136/svn-2020-000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
Background and purpose Early neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA). Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. We collected clinical variables and initial haematological and neuroimaging findings. MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere. The degree of hyperintensity of MHVs was classified into four grades: none, subtle, moderate and extensive. END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms. Multivariate logistic regressions were conducted to investigate the predictors of END. Results The study included 61 patients (51 males and 10 females) with a mean age of 62.4±12.6 years. Thirty-five (57.4%) patients presented with MHVs: 8 (13.1%) were graded as subtle MHVs, while 23 (37.7%) and 4 (6.6%) were graded as moderate or extensive MHVs, respectively. Twenty patients (32.8%) presented with END. Logistic regression analysis showed that compared with patients without MHVs, moderate MHVs (adjusted OR 5.446, 95% CI 1.360 to 21.800; p=0.017) and extensive MHVs (adjusted OR 15.240, 95% CI 1.200 to 193.544; p=0.036) were significantly associated with END. Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Han-Peng Yin
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Zhi-Hao Lu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Fang Wang
- Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Man-Qiu Liang
- Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
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24
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Fan AP, Khalil AA, Fiebach JB, Zaharchuk G, Villringer A, Villringer K, Gauthier CJ. Elevated brain oxygen extraction fraction measured by MRI susceptibility relates to perfusion status in acute ischemic stroke. J Cereb Blood Flow Metab 2020; 40:539-551. [PMID: 30732551 PMCID: PMC7026852 DOI: 10.1177/0271678x19827944] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent clinical trials of new revascularization therapies in acute ischemic stroke have highlighted the importance of physiological imaging to identify optimal treatments for patients. Oxygen extraction fraction (OEF) is a hallmark of at-risk tissue in stroke, and can be quantified from the susceptibility effect of deoxyhemoglobin molecules in venous blood on MRI phase scans. We measured OEF within cerebral veins using advanced quantitative susceptibility mapping (QSM) MRI reconstructions in 20 acute stroke patients. Absolute OEF was elevated in the affected (29.3 ± 3.4%) versus the contralateral hemisphere (25.5 ± 3.1%) of patients with large diffusion-perfusion lesion mismatch (P = 0.032). In these patients, OEF negatively correlated with relative CBF measured by dynamic susceptibility contrast MRI (P = 0.004), suggesting compensation for reduced flow. Patients with perfusion-diffusion match or no hypo-perfusion showed less OEF difference between hemispheres. Nine patients received longitudinal assessment and showed OEF ratio (affected to contralateral) of 1.2 ± 0.1 at baseline that normalized (decreased) to 1.0 ± 0.1 at follow-up three days later (P = 0.03). Our feasibility study demonstrates that QSM MRI can non-invasively quantify OEF in stroke patients, relates to perfusion status, and is sensitive to OEF changes over time. Clinical trial registration: Longitudinal MRI examinations of patients with brain ischemia and blood brain barrier permeability; clinicaltrials.org :NCT02077582.
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Affiliation(s)
- Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ahmed A Khalil
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudine J Gauthier
- Department of Physics, Concordia University, Montreal, Canada.,Montreal Heart Institute, Montreal, Canada
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25
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Darwish EAF, Abdelhameed-El-Nouby M, Geneidy E. Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging. Insights Imaging 2020; 11:6. [PMID: 31930428 PMCID: PMC6955386 DOI: 10.1186/s13244-019-0810-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patients Methods Twenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS). Results IG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ2 = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (rs = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (rs = 0.788, p = 0.000) Conclusion A positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
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Affiliation(s)
- Eman A F Darwish
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt.
| | | | - Eman Geneidy
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt
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26
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Nersesyan N, Arnold S, Krieg P. Susceptibility-Weighted Imaging Findings in Patients Suffering from Migraine with Aura. Clin Neuroradiol 2019; 29:783-785. [PMID: 30887092 DOI: 10.1007/s00062-019-00775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Nerses Nersesyan
- Dept. Radiology, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010, València, Spain.
| | - Sebastian Arnold
- Dept. Radiology, Section Neuroradiology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Peter Krieg
- Dept. Pediatrics, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
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27
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Kim P, Langheinrich K, Cristiano B, Grigsby P, Oyoyo U, Kido D, Paul Jacobson J. Low thalamostriate venous quantitative susceptibility measurements correlate with higher presenting NIH stroke scale score in emergent large vessel occlusion stroke. J Int Med Res 2019; 48:300060519832462. [PMID: 30859887 PMCID: PMC7140206 DOI: 10.1177/0300060519832462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Hyperacute stroke affects various patient subgroups who may benefit from
different management strategies. Magnetic resonance imaging (MRI)
quantitative susceptibility mapping (QSM) is a recent MRI technique for
measuring deoxyhemoglobin levels. The results of QSM thus have the potential
to act as a quantitative biomarker for predicting the success of
endovascular interventions. Methods Twenty-five patients with M1 occlusions were evaluated retrospectively. QSM
measurements were obtained based on susceptibility-weighted imaging
sequences from the most prominent veins in each of the four standard regions
of interest: the cortical and thalamostriate veins ipsilateral and
contralateral to the side of the stroke. The results were analyzed using
Wilcoxon’s signed rank test and compared with presenting National Institutes
of Health stroke scale (NIHSS) score. Results Cortical veins ipsilateral to the stroke showed the greatest elevation in
susceptibility compared with all other vein groups. Both ipsilateral and
contralateral thalamostriate vein susceptibilities showed strong inverse
correlation with presenting NIHSS score. Conclusion Thalamostriate vein susceptibility shows a strong inverse correlation with
presenting NIHSS in adult patients with hyperacute stroke who are selected
for endovascular intervention by advanced imaging.
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Affiliation(s)
- Paggie Kim
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Brian Cristiano
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Phillip Grigsby
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Udo Oyoyo
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Daniel Kido
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - J Paul Jacobson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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28
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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.
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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
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29
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Xu J, Chen X, Lin M. Significance of Magnetic Resonance Imaging (MRI) T2 Hyperintense Endo-Vessels Sign in Progressive Posterior Circulation Infarction. Med Sci Monit 2018; 24:3873-3881. [PMID: 29882523 PMCID: PMC6022782 DOI: 10.12659/msm.908300] [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] [Indexed: 11/28/2022] Open
Abstract
Background MRI FLAIR hyperintense vessels sign (FHVs) is a special imaging marker that plays a key role in acute infarction imaging and diagnosis. However, FHVs have not been studied in the context of progressive posterior circulation infarction (PPCI), and little is known about the association of hyperintense endo-vessels sign (HEVs) on transverse section MRI with infarction. Thus, our objective here was to investigate the clinical significance of transverse MRI T2 HEVs in patients with PPCI. Material/Methods In this retrospective, case-control study, we enrolled 100 consecutive posterior circulation infarction patients. All the patients underwent head MRI examinations on the onset day and the seventh day after admission. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) scores upon admission and after 7 days. Infarction volume on DWI was compared. Results HEVs were detected in 25 of 37 patients in the PPCI group (67.6%) and 22 of 63 patients in the NPPCI group (34.9%). Logistic regression analysis showed that the proportion of HEVs in the PPCI group was higher than in the NPPCI group (P=0.007). Among all the patients, HEVs were detected in 15 of 18 patients (83.3%) with occlusion of the vertebral artery or basilar artery, and 17 of 23 (73.9%) showed severe stenosis. The proportion of vertebrobasilar artery occlusions in the PPCI group was higher than in the NPPCI group (P<0.05). MRI DWI showed that 20 patients had cerebellum infarction among 23 vertebral artery HEVs patients, and 14 patients had brainstem infarction among 15 basilar artery HEVs patients. All of the 9 vertebral and basilar artery HEVs patients had brainstem infarction. The increase in NIHSS scores from baseline to 7 days was significantly greater in patients with HEVs than in patients without HEVs in the PPCI group (P=0.002). The expansion of the infarction size from baseline to 7 days was significantly larger in patients with HEVs than in patients without HEVs in the PPCI group (P=0.037). Conclusions HEVs are frequently detected in patients with vertebrobasilar artery territory infarction, and they can be considered as a special imaging marker for vertebral artery and basilar artery occlusion and severe stenosis. HEVs can indicate whether or not posterior circulation infarction progresses and they may be an independent risk factor of PPCI.
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Affiliation(s)
- Jialiang Xu
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Xiaohong Chen
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Muhui Lin
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
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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.
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Yamaguchi S, Horie N, Morikawa M, Tateishi Y, Hiu T, Morofuji Y, Izumo T, Hayashi K, Matsuo T. Assessment of veins in T2*-weighted MR angiography predicts infarct growth in hyperacute ischemic stroke. PLoS One 2018; 13:e0195554. [PMID: 29617449 PMCID: PMC5884555 DOI: 10.1371/journal.pone.0195554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed. Acute recanalization was defined as an arterial occlusive lesion score of 2-3. A modified Alberta Stroke Program Early CT Score (mASPECTS) was used to evaluate ischemic areas revealed by SWAN and DWI. SWAN- and DWI-based mASPECTSs were calculated, and correlations between DWI-SWAN mismatches with final infarct lesions or clinical outcomes were evaluated. RESULTS Among the 35 patients included in this study, we confirmed cardioembolic stroke in 26, atherothrombotic stroke in 4, and unknown stroke etiology in 5. Overall, recanalization was achieved in 23 patients, who showed a higher follow-up DWI-based mASPECTS and lower modified Rankin Scale (mRS) score at 90 days than patients without recanalization. Initial SWAN- and follow-up DWI-based mASPECTSs were significantly higher for atherothrombotic stroke than for cardioembolic stroke. Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth. Patients with recanalization showed no such correlation. In the assessment of clinical outcome, follow-up DWI-based mASPECTS and patient's age were significantly correlated with mRS at 90 days after stroke. A multivariate logistic regression analysis revealed that the follow-up DWI-based mASPECTS was independently associated with a favorable outcome 90 days after stroke. CONCLUSIONS For patients with AIS, DWI-SWAN mismatch might show penumbra-like lesions that would predict infarct growth without acute recanalization. Assessment of ischemic lesions from the venous side appears to be useful for considering the etiology and revascularization therapy.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kentaro Hayashi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Yu J, Wang L, Li Z, Wang S, Wang G. Related Factors of Asymmetrical Vein Sign in Acute Middle Cerebral Artery Stroke and Correlation with Clinical Outcome. J Stroke Cerebrovasc Dis 2017. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Park MG, Yeom JA, Baik SK, Park KP. Total mismatch of diffusion-weighted imaging and susceptibility-weighted imaging in patients with acute cerebral ischemia. J Neuroradiol 2017; 44:308-312. [PMID: 28579039 DOI: 10.1016/j.neurad.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/21/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) is associated with an increased oxygen demand in acute cerebral ischemia. Occasionally, some patients exhibit extensive MHV on SWI despite of negative diffusion-weighted imaging (DWI), which is a phenomenon called total mismatch DWI-SWI. We analyzed the clinical characteristics and imaging findings in patients with the total DWI-SWI mismatch. MATERIALS AND METHODS We selected patients with total DWI-SWI mismatch who underwent MRI within 12hours from onset. To evaluate the degree of collateral flow, we graded vessels on post-contrast time-of-flight MR angiography as 3 groups. Perfusion lesion volume was measured using threshold of>6seconds of mean transit time on perfusion-weighted imaging. RESULTS Total DWI-SWI mismatch was found in 10 (2.7%) out of 370 patients. Four out of 10 patients were excluded due to lack of data on perfusion studies. Hence 6 patients were finally selected in the study. Two patients with internal carotid artery dissection were treated with emergent stenting, one patient with intravenous thrombolysis and mechanical thrombectomy, and two patients with drug-induced hypertension. All of the enrolled patients exhibited extensive MHV on SWI and good collateral flows. The mean perfusion lesion volume was 72.6±15.3ml (range 0-325.0ml). Clinical outcome was favorable in all of the patients (mRS at 3 months, 0). CONCLUSIONS Our results demonstrate that total mismatch of DWI-SWI is associated with good collateral flow and may be a predictor of good response to treatment in patients with acute cerebral ischemia.
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Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum, 50612 Yangsan, Republic of Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seung Kug Baik
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kyung-Pil Park
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum, 50612 Yangsan, Republic of Korea.
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Vanaerde O, Budzik JF, Mackowiak A, Norberciak L, Uettwiller M, Leclerc X, Verclytte S. Comparison between enhanced susceptibility-weighted angiography and time of flight sequences in the detection of arterial occlusion in acute ischemic stroke. J Neuroradiol 2017; 44:210-216. [PMID: 28258760 DOI: 10.1016/j.neurad.2017.01.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/14/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Optimizing the MRI protocol in acute ischemic stroke remains a challenging issue. In this field, susceptibility-weighted sequences have proved their superiority over T2*. Besides the strengthened susceptibility effect, enhanced susceptibility-weighted angiography (eSWAN) sequence provides also a time-of-flight (TOF) effect, allowing the exploration of the intracranial arterial circulation. The objective of our study was to compare eSWAN and 3D TOF, considered as the reference, in the detection of arterial occlusion in acute stroke. METHODS Patients who underwent MRI between March and July 2014 for suspected acute stroke with an acute ischemic lesion on diffusion-weighted imaging (DWI) were prospectively included in this study. eSWAN and TOF images were analyzed under double-blind conditions by a junior radiologist and a senior neuroradiologist for the detection of arterial occlusion. eSWAN images were assessed in order to estimate the inter-observer agreement. After a consensus, eSWAN and TOF data were compared to calculate inter-modality agreement. RESULTS Thirty-four patients were included. Inter-observer agreement was excellent (kappa: 0.96) for eSWAN detection of occlusion. After consensus, comparison between TOF and eSWAN showed substantial agreement (kappa: 0.71). eSWAN provided better detection of distal occlusions, but poorer performance for detection of siphon occlusions. CONCLUSIONS Shortest echoes eSWAN images enabled detection of arterial occlusion with substantial agreement with TOF images. The susceptibility vessel sign associated with the TOF effect improved the identification of distal occlusions. In acute stroke protocol, eSWAN may represent a valuable alternative to T2* and TOF sequences.
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Affiliation(s)
- O Vanaerde
- Department of radiology, Catholic university hospitals, 115, rue du Grand-But-Lomme, 59160 Lille, France.
| | - J-F Budzik
- Department of radiology, Catholic university hospitals, 115, rue du Grand-But-Lomme, 59160 Lille, France
| | - A Mackowiak
- Department of neurology, Stroke unit, Catholic university hospitals, 59160 Lille, France
| | - L Norberciak
- Clinical research department, Catholic university hospitals, 59160 Lille, France
| | | | - X Leclerc
- Neuroimaging department, CHU de Lille, 59000 Lille, France
| | - S Verclytte
- Department of radiology, Catholic university hospitals, 115, rue du Grand-But-Lomme, 59160 Lille, France
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Hsu CCT, Kwan GNC, Hapugoda S, Craigie M, Watkins TW, Haacke EM. Susceptibility weighted imaging in acute cerebral ischemia: review of emerging technical concepts and clinical applications. Neuroradiol J 2017; 30:109-119. [PMID: 28424015 DOI: 10.1177/1971400917690166] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Susceptibility weighted imaging (SWI) is an essential magnetic resonance imaging sequence in the assessment of acute ischemic stroke. In this article, we discuss the physics principals and clinical application of conventional SWI and multi-echo SWI sequences. We review the research evidence and practical approach of SWI in acute ischemic stroke by focusing on the detection and characterization of thromboembolism in the cerebral circulation. In addition, we discuss the role of SWI in the assessment of neuroparenchyma by depiction of asymmetric hypointense cortical veins in the ischemic territory (surrogate tissue perfusion), detection of existing microbleeds before stroke treatment and monitoring for hemorrhagic transformation post-treatment. In conclusion, the SWI sequence complements other parameters in the stroke magnetic resonance imaging protocol and understanding of the research evidence is vital for practising stroke neurologists and neuroradiologists.
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Affiliation(s)
- Charlie Chia-Tsong Hsu
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia.,2 Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gigi Nga Chi Kwan
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia
| | | | - Michelle Craigie
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia
| | | | - E Mark Haacke
- 3 Departments of Radiology and Biomedical Engineering, Wayne State University, USA
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Cheng B, Schröder N, Forkert ND, Ludewig P, Kemmling A, Magnus T, Fiehler J, Gerloff C, Thomalla G. Hypointense Vessels Detected by Susceptibility-Weighted Imaging Identifies Tissue at Risk of Infarction in Anterior Circulation Stroke. J Neuroimaging 2016; 27:414-420. [PMID: 28000975 DOI: 10.1111/jon.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The diagnostic value of susceptibility-weighted magnetic resonance imaging of acute stroke patients has shown potential as a surrogate marker of impaired hemodynamics. We investigate the value of asymmetrical hypointense cerebral vessels (HV) for the identification of vessel status and tissue at risk of infarction (TaR). METHODS Symmetry of HV was visually rated on SWI data from a well-defined population of acute anterior circulation stroke with onset <24 hours. MRI perfusion data was analyzed and volumes of tissue at risk segmented using a delay threshold of Tmax> 6 seconds. Status of the extra- and intracranial arteries was assessed by ultrasound and MR angiography. RESULTS 35 patients were included (12 women; median age 69 years, IQR 61-77; median NIHSS at admission 10, IQR 6-20). Asymmetrically distributed HV were detected at the stroke hemisphere in 25 patients (71%). Of those, 12 patients displayed occlusion of the middle cerebral artery, whereas occlusion of the extracranial ICA was detected in 6 patients. TaR was larger, yet not significantly different in patients with asymmetrically HV (mean volume 38.9 ml, SD 52.9 ml) compared to patients showing symmetrical HV (4.2 ml; SD 10.7 ml, p-value 0.081). Significant differences where, however, found after excluding patients with extracranial ICA occlusions (42.9 ml; SD 50.4 ml vs. 4.2 ml, SD 10.8 ml, p-value 0.025). CONCLUSION Visual analysis of HV in SWI identifies tissue at risk in patients with anterior circulation stroke. Potentially pre-existing extracranial ICA occlusions leading to prominent HV have to be considered as a confounding factor.
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Affiliation(s)
- Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N4N1, Canada
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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ASL and susceptibility-weighted imaging contribution to the management of acute ischaemic stroke. Insights Imaging 2016; 8:91-100. [PMID: 27822669 PMCID: PMC5265193 DOI: 10.1007/s13244-016-0529-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 12/04/2022] Open
Abstract
Abstract Magnetic resonance imaging (MRI) plays a central role in the early diagnosis of cerebral vascular events. Today, MRI is used not only for the detection of acute ischaemic lesions, but also to fine tune the diagnosis and improve patient selection for early therapeutic decision-making. In this perspective, new tools such as arterial spin labelling (ASL) and susceptibility-weighted imaging (SWI) sequences have been developed. These MRI sequences enable noninvasive assessment of brain damage, providing important diagnostic and prognostic information: evaluation of cerebral parenchymal perfusion; detection and aetiological assessment of thrombi; ruling out differential diagnoses. After a brief recall of the fundamental basis of these sequences, this article proposes an update on their current contribution to the early management of stroke victims. Teaching Points • These noninvasive sequences provide essential information for early management of acute stroke. • They can detect zones of parenchymal hypoperfusion. • Susceptibility-weighted sequences provide information on thrombus localisation and composition. • ASL can identify certain aetiologies of stroke mimics. • Post-therapeutic ASL perfusion status predicts outcome.
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Luo Y, Gong Z, Zhou Y, Chang B, Chai C, Liu T, Han Y, Wang M, Qian T, Haacke EM, Xia S. Increased susceptibility of asymmetrically prominent cortical veins correlates with misery perfusion in patients with occlusion of the middle cerebral artery. Eur Radiol 2016; 27:2381-2390. [PMID: 27655300 DOI: 10.1007/s00330-016-4593-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 08/30/2016] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To evaluate tissue perfusion and venous susceptibility in ischaemic stroke patients as a means to predict clinical status and early prognosis. METHODS A retrospective study of 51 ischaemic stroke patients were enrolled in this study. Susceptibility, perfusion and National Institute of Health stroke scale (NIHSS) were compared between patients with and without asymmetrically prominent cortical veins (APCVs). The correlation between susceptibility, perfusion and NIHSS was performed. RESULTS Compared to patients without APCVs, the age of patients with APCVs was statistically older (p = 0.017). Patients with APCVs at discharge showed clinical deterioration in their NIHSS. Mean transit time (MTT), time to peak (TTP) and cerebral blood flow (CBF) in the stroke hemisphere were statistically delayed/decreased in patients with and without APCVs (all p < 0.05). In patients with APCVs, the changes in susceptibility positively correlated with increases in MTT and TTP (p < 0.05). Susceptibility and TTP positively correlated and CBF negatively correlated with NIHSS both at admission and discharge (p < 0.05). CONCLUSIONS Patients with APCVs have a tendency of deterioration. The presence of APCVs indicates the tissue has increased oxygen extraction fraction. Increased susceptibility from APCVs positively correlated with the delayed MTT and TTP, which reflects the clinical status at admission and predicts an early prognosis. KEY POINTS • Patients with and without APCVs have similar misery perfusion. • Patients with APCVs have a tendency of deterioration compared to those without. • The presence of APCVs indicated the tissue has increased oxygen extraction fraction. • Increased susceptibility from APCVs positively correlated with the MTT and TTP. • Increased susceptibility from APCVs reflected the clinical status at admission.
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Affiliation(s)
- Yu Luo
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Zhongying Gong
- Neurological Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Yongming Zhou
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Binge Chang
- Neurosurgery Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Chao Chai
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Taiyuan Liu
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Yanhong Han
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Meiyun Wang
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003.
| | - Tianyi Qian
- Siemens Healthcare, MR collaboration, Northeast Asia, No.7, Wangjing Zhonghuan South Road, Beijing, China, 100102
| | - E Mark Haacke
- Radiology Department, Wayne State University, Detroit, MI, USA
| | - Shuang Xia
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192.
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Kim KT, Baik SG, Park KP, Park MG. A Case of Complete Recovery of Fluctuating Monocular Blindness Following Endovascular Treatment in Internal Carotid Artery Dissection. J Stroke Cerebrovasc Dis 2015. [PMID: 26194847 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Monocular blindness may appear as the first symptom of internal carotid artery dissection (ICAD). However, there have been no reports that monocular visual loss repeatedly occurs and disappears in response to postural change in ICAD. METHODS A 33-year-old woman presented with transient monocular blindness (TMB) following acute-onset headache. TMB repeatedly occurred in response to postural change. Two days later, she experienced transient dysarthria and right hemiparesis in upright position. Pupil size and light reflex were normal, but a relative afferent pupillary defect was positive in the left eye. Diffusion-weighted imaging showed no acute lesion, but perfusion-weighted imaging showed perfusion delay in the left ICA territory. Digital subtraction angiography demonstrated a false lumen and an intraluminal filling defect in proximal segment of the left ICA. RESULTS Carotid stenting was performed urgently. After carotid stenting, left relative afferent pupillary defect disappeared and TMB was not provoked anymore by upright posture. At discharge, left visual acuity was completely normalized. CONCLUSIONS Because fluctuating visual symptoms in the ICAD may be associated with hemodynamically unstable status, assessment of the perfusion status should be done quickly. Carotid stenting may be helpful to improve the fluctuating visual symptoms and hemodynamically unstable status in selected patient with the ICAD.
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Affiliation(s)
- Ki-Tae Kim
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seung Guk Baik
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kyung-Pil Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Min-Gyu Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Vachha BA, Schaefer PW. Imaging Patterns and Management Algorithms in Acute Stroke: An Update for the Emergency Radiologist. Radiol Clin North Am 2015; 53:801-26, ix. [PMID: 26046512 DOI: 10.1016/j.rcl.2015.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neuroimaging plays a key role in the initial work-up of patients with symptoms of acute stroke. Understanding the advantages and limitations of available CT and MR imaging techniques and how to use them optimally in the emergency setting is crucial for accurately making the diagnosis of acute stroke and for rapidly determining appropriate treatment.
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Affiliation(s)
- Behroze A Vachha
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Pamela W Schaefer
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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