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Yun T, Lee KI, Koo Y, Kim H, Chang D, Lee C, Yang MP, Kang BT. Diffusion-Weighted Imaging Findings of Ischemic Spinal Injury in a Chondrodystrophic Dog With Fibrocartilaginous Embolism. Front Vet Sci 2020; 7:598792. [PMID: 33363237 PMCID: PMC7758316 DOI: 10.3389/fvets.2020.598792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
A 9-year-old, intact male Shih Tzu dog presented with systemic weakness and peracute onset of tetraplegia. Tetraplegia with lower motor neuron signs was noted upon neurological examination. Diseases that cause acute flaccid tetraparesis, such as acute fulminating myasthenia gravis, polyradiculoneuritis, tick paralysis, and botulism, were ruled out based on the medical history, normal electrophysiological tests, and non-response to the neostigmine challenging test. Initial 0.3-Tesla (T) magnetic resonance imaging (MRI) findings included sharply demarcated intramedullary lesions at the C3-C6 level, mainly involving gray matter, which appeared hypo- to iso- intense on T1-weighted images (WIs), and hyperintense on T2-WIs and fluid-attenuated inversion recovery images. There was no enhancement on post-contrast T1-WIs. Neutrophilic pleocytosis was observed in the cerebrospinal fluid analysis. No clinical responses were observed for the treatment of non-infectious myelitis with an immunosuppressive dosage of prednisolone. A follow-up 3-T MRI 6 days later demonstrated hyperintensity on diffusion-WI (DWI) and a decreased apparent diffusion coefficient (ADC) value (0.54 × 10-3 mm2/s) of the spinal lesions. Through histological examination, a fibrocartilaginous embolism was definitively confirmed. This is the first report to describe an ischemic spinal injury visualized by DWI and ADC mapping with high-field MRI in a chondrodystrophic dog diagnosed with a fibrocartilaginous embolism.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kang-Il Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Dongwoo Chang
- Section of Veterinary Medical Imaging, Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Chulhyun Lee
- Division of Convergence Biotechnology, Korea Basic Science Institute, Ochang, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
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Weston P, Morales C, Dunning M, Parry A, Carrera I. Susceptibility weighted imaging at 1.5 Tesla magnetic resonance imaging in dogs: Comparison with T2*-weighted gradient echo sequence and its clinical indications. Vet Radiol Ultrasound 2020; 61:566-576. [PMID: 32663373 DOI: 10.1111/vru.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/30/2022] Open
Abstract
Susceptibility weighted imaging (SWI) is a high resolution, fully velocity-compensated, three-dimensional gradient echo (GE) MRI technique. In humans, SWI has been reported to be more sensitive than T2*-weighted GE sequences in the identification of both intracranial hemorrhage and intra-vascular deoxyhemoglobin. However, published clinical studies comparing SWI to T2*-weighted GE sequences in dogs are currently lacking. The aim of this retrospective, observational study was to compare SWI and T2*-weighted GE sequences in a group of dogs with intracranial disease. Medical records were searched for dogs that underwent a brain MRI examination that included T2*-weighted GE and SWI sequences. The presence and appearance of non-vascular and vascular signal voids observed on T2*-weighted GE and SWI were compared. Thirty-two dogs were included with the following diagnoses: presumed and confirmed intracranial neoplasia (27), cerebrovascular accidents (3), and trauma (2). Hemorrhagic lesions were significantly more conspicuous on SWI than T2*-weighted GE sequences (P < .0001). Venous structures were well defined in all SWI sequences, and poorly defined in all dogs on T2*-weighted GE. Susceptibility weighted imaging enabled identification of vascular abnormalities in 30 of 32 (93.8%) dogs, including: neovascularization in 19 of 32 (59.4%) dogs, displacement of perilesional veins in five of 32 (15.6%) dogs, and apparent dilation of perilesional veins in 10 of 32 (31.3%) dogs. Presence of neovascularization was significantly associated with T1-weighted post-contrast enhancement (P = .0184). Hemorrhagic lesions and venous structures were more conspicuous on SWI compared to T2*-weighted GE sequences. Authors recommend adding SWI to standard brain protocols in dogs for detecting hemorrhage and identifying venous abnormalities for lesion characterization.
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Affiliation(s)
| | | | - Mark Dunning
- Willows Referral Centre, Solihull, UK.,School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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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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Wang Y, Zhang H, Wang Z, Liu H, Tian X, Yu J, Chen C. Therapeutic effect of nerve growth factor on canine cerebral infarction evaluated by MRI. Oncotarget 2018; 9:3741-3751. [PMID: 29423079 PMCID: PMC5790496 DOI: 10.18632/oncotarget.23345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022] Open
Abstract
To explore therapeutic effect of nerve growth factor (NGF) on cerebral infarction by establishing canine middle cerebral artery occlusion (MCAO) infarct model. The magnetic resonance imaging (MRI) technology was used to study effects of NGF on cerebral infarction, and the results of MRI indexes (such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI)) were compared with the results of pathology, cell biology and molecular biology. The clinical manifestations of the canine infarction model treated by NGF were significantly improved within 7 days compared with control group. The therapeutic evaluation of NGF effect could be determine by canine cerebral infarction treated by NGF within 6 hours according to DWI and PWI. From 6 hours to 7 days, therapeutic evaluation of NGF could be determine by T1WI, T2WI and FLAIR. DWI and PWI could find the change of cerebral ischemia at the early stage, provide advantages for qualitative diagnosis of early-stage cerebral infarction and observation of efficacy in early treatment, initially showing that their great potential for NGF role on cerebral ischemia and mechanism.
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Affiliation(s)
- Yong Wang
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
| | - Hui Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang, Hebei Province 050051, China
| | - Zhe Wang
- Department of Computer Science, Clinical College of Hebei Medical University, Shijiazhuang, Hebei Province 050031, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
| | - Xin Tian
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
| | - Jian Yu
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
| | - Chaoxu Chen
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
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Xu XH, Gao T, Zhang WJ, Tong LS, Gao F. Remote Diffusion-Weighted Imaging Lesions in Intracerebral Hemorrhage: Characteristics, Mechanisms, Outcomes, and Therapeutic Implications. Front Neurol 2017; 8:678. [PMID: 29326644 PMCID: PMC5736543 DOI: 10.3389/fneur.2017.00678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/28/2017] [Indexed: 01/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) is one of the most fatal form of stroke, with high mortality and disability rate. Small diffusion-weighed imaging lesions are not rare to see in regions remote from the hematoma after ICH and have been generally considered as related with poor outcome. In this review, we described the characteristics of remote ischemic lesions, discussed the possible mechanisms and clinical outcomes of these lesions, and evaluated the potential therapeutic implications.
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Affiliation(s)
- Xu-Hua Xu
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Ting Gao
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Ji Zhang
- Department of Radiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Lu-Sha Tong
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Gao
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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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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Taoka T, Fukusumi A, Miyasaka T, Kawai H, Nakane T, Kichikawa K, Naganawa S. Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders. Radiographics 2017; 37:281-297. [PMID: 28076020 DOI: 10.1148/rg.2017160061] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. ©RSNA, 2017.
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Affiliation(s)
- Toshiaki Taoka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Akio Fukusumi
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiteru Miyasaka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Hisashi Kawai
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiki Nakane
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Kimihiko Kichikawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Shinji Naganawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
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Bhaskar S, Bivard A, Parsons M, Nilsson M, Attia JR, Stanwell P, Levi C. Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: Associations with collateral status. J Cereb Blood Flow Metab 2017; 37:671-682. [PMID: 26965242 PMCID: PMC5381457 DOI: 10.1177/0271678x16637611] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p ≤ 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p ≤ 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p ≤ 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p ≤ 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.
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Affiliation(s)
- Sonu Bhaskar
- 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.,2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia
| | - Andrew Bivard
- 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia
| | - Mark Parsons
- 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.,2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia
| | - Michael Nilsson
- 2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.,3 Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - John R Attia
- 4 Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, University of Newcastle, NSW, Australia
| | - Peter Stanwell
- 2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia
| | - Christopher Levi
- 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.,2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia
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9
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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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10
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Association of Cortical Vein Filling with Clot Location and Clinical Outcomes in Acute Ischaemic Stroke Patients. Sci Rep 2016; 6:38525. [PMID: 27917948 PMCID: PMC5137111 DOI: 10.1038/srep38525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/11/2016] [Indexed: 01/19/2023] Open
Abstract
Delay in cortical vein filling during the late-venous phase (delayed-LCVF) is characterized by opacification of cerebral veins despite contrast clearance from contralateral veins on dynamic computed tomography angiography (dCTA) in acute ischemic stroke (AIS) patients. The aim of the study was to investigate the associations of delayed-LCVF with clot location, reperfusion status at 24 hours, and 90-days functional outcome in AIS patients who received reperfusion therapy. A prospective cohort of AIS patients treated with intravenous thrombolysis was studied. Groupwise comparison, univariate, and multivariate regression analyses were used to study the association of delayed-LCVF with clot location and clinical outcomes. Of 93 patients (mean age = 72 ± 12 years) with hemispheric AIS included in the study, 46 (49%) demonstrated delayed-LCVF. Patients with delayed-LCVF demonstrated a significantly higher proportion of proximal occlusion (72% vs 13%, P =< 0.0001), and poor reperfusion at 24 hours (41% vs 11%, P = 0.001). The proportion of poor functional outcome at 90 days was not significantly different (22/56 (48%) vs 17/61 (36%), P = 0.297). The appearance of delayed-LCVF on baseline dCTA may be a surrogate for large vessel occlusion, and an early marker for poor 24-hour angiographic reperfusion.
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11
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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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Zhou M, Mao L, Wang Y, Wang Q, Yang Z, Li S, Li L. Morphologic Changes of Cerebral Veins in Hypertensive Rats: Venous Collagenosis Is Associated with Hypertension. J Stroke Cerebrovasc Dis 2015; 24:530-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022] Open
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Park MG, Yang TI, Oh SJ, Baik SK, Kang YH, Park KP. Multiple hypointense vessels on susceptibility-weighted imaging in acute ischemic stroke: surrogate marker of oxygen extraction fraction in penumbra? Cerebrovasc Dis 2014; 38:254-61. [PMID: 25401484 DOI: 10.1159/000367709] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) are frequently observed in patients with acute cerebral ischemia, but their implication has not been clearly established. To elucidate the clinical significance of MHV on SWI, we investigated the association of MHV on SWI with clinical data and other MR markers in patients with acute ischemic stroke. METHODS We enrolled acute stroke patients with internal carotid or proximal middle cerebral artery occlusion who underwent MRI including SWI within 3 days from stroke onset. Baseline clinical data were reviewed. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). We graded the degree of MHV on SWI as four groups of none, subtle, relative, or extensive by the modified Alberta Stroke Program Early CT Scan (ASPECTS) system. To evaluate the degree of collateral flow, distal hyperintense vessels (DHV) on FLAIR and vessels on post-contrast time-of-flight MR angiography (TOF MRA) source images were graded respectively as 3 groups: none/subtle/prominent and poor/moderate/good. Diffusion and perfusion lesion volume and diffusion-perfusion mismatch (DPM) ratio were measured in all patients. We analyzed the association of the degree of MHV on SWI with clinical data and MR markers. RESULTS Eighty patients were included in the study. The mean MR time from stroke onset was 12.4 h (range 0.5-63.0). There is no difference in MR time from stroke onset between groups of MHV on SWI. MHV were observed in 68 (85%) of 80 patients: none in 12, subtle in 11, relative in 13, and extensive in 44. There were no statistically significant associations between MHV on SWI and vascular risk factors. Patients with more extensive MHV on SWI had a smaller diffusion volume (p < 0.001), larger DPM (p < 0.001), and lower initial NIHSS scores (p = 0.022). Prominent DHV was presented in 29 of 44 patients with extensive MHV (p < 0.001). Good collateral flow on TOF MRA source images was presented in 37 of 44 patients with extensive MHV (p < 0.001). CONCLUSIONS More extensive MHV on SWI in acute ischemic stroke is associated with lower initial NIHSS scores, smaller diffusion lesion volume, better collateral flow, and larger DPM. Our results show the possibility that MHV on SWI may be a useful surrogate marker for predicting increased oxygen extraction fraction and diffusion-perfusion mismatch in acute ischemic hemisphere.
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Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Li Q, Khatibi N, Zhang JH. Vascular neural network: the importance of vein drainage in stroke. Transl Stroke Res 2014; 5:163-6. [PMID: 24563018 PMCID: PMC3985555 DOI: 10.1007/s12975-014-0335-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 01/27/2023]
Abstract
This perspective commentary summarized the stroke pathophysiology evolution, especially the focus in the past on neuroprotection and neurovascular protection and highlighted the newer term for stroke pathophysiology: vascular neural network. Emphasis is on the role of venules and veins after an acute stroke and as potential treatment targets. Vein drainage may contribute to the acute phase of brain edema and the outcomes of stroke patients.
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Affiliation(s)
- Qian Li
- Department of Neurology, The Fifth People's Hospital of Chongqing, Chongqing, China, 400062
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