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Park PSW, Yogendrakumar V, Yassi N, Campbell BCV. Persistent Posterior Fossa Hypoperfusion in the Setting of Vertebrobasilar Dolichoectasia. Stroke 2022; 53:e276-e281. [PMID: 35620991 DOI: 10.1161/strokeaha.122.038527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter S W Park
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.S.W.P., V.Y., N.Y., B.C.V.C.)
| | - Vignan Yogendrakumar
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.S.W.P., V.Y., N.Y., B.C.V.C.)
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.S.W.P., V.Y., N.Y., B.C.V.C.).,Population Health and Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.S.W.P., V.Y., N.Y., B.C.V.C.)
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Del Brutto VJ, Gutierrez J, Goryawala MZ, Sacco RL, Rundek T, Romano JG. Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke. Stroke 2021; 52:2311-2318. [PMID: 33980042 DOI: 10.1161/strokeaha.120.032225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Victor J Del Brutto
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose Gutierrez
- Department of Neurology, Mailman School of Public Health, Columbia University (J.G.)
| | - Mohammed Z Goryawala
- Departments of Radiology (M.Z.G.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
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Apfaltrer P, Wenz H, Böhme J, Gawlitza M, Groden C, Alonso A, Förster A. FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis. Clin Neuroradiol 2020; 31:827-831. [PMID: 32865598 DOI: 10.1007/s00062-020-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Occlusion or significant stenosis of the internal carotid artery (ICA) in the cervical segment is commonly associated with a poststenotic decrease in the downstream blood flow and perfusion. Fluid attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are a phenomenon that represents slow arterial blood flow. In this study, we investigated the frequency and extent of FVH in the distal ICA in patients with proximal ICA stenosis. METHODS We analyzed the magnetic resonance imaging (MRI) findings in 51 patients with a total of 60 cervical ICA stenoses with special focus on the frequency and extent of FVH in the area of the petrous segment of the ICA on FLAIR images and correlated these with Doppler/duplex sonography results. RESULTS In 46 (76.7%) patients with ICA stenosis, FVH could be detected in the petrous segment of the ICA: in 19 (41.3%) patients a thin hyperintense rim near the vessel wall (grade 1), in 24 (52.2%) patients a strong hyperintense rim near the vessel wall (grade 2), and in 3 (6.5%) patients a hyperintense filling of the entire lumen (grade 3) was observed. The extent of FVH in the ICA in the petrous segment showed a high negative correlation with the poststenotic flow velocity (Spearman correlation, R = -0.75, p < 0.001), and moderate correlation with the degree of ICA stenosis (Spearman correlation, R = 0.51, p< 0.001). CONCLUSION An FVH in the petrous ICA is commonly seen among patients with steno-occlusive disease in proximal ICA and could therefore be useful to recognize a proximal ICA stenosis even on FLAIR images.
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Affiliation(s)
- Paul Apfaltrer
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Cao L, Zhu C, Eisenmenger L, Du X, Liu J, Yang Q, Lu J, Li K, Saloner D. Wall enhancement characteristics of vertebrobasilar nonsaccular aneurysms and their relationship to symptoms. Eur J Radiol 2020; 129:109064. [DOI: 10.1016/j.ejrad.2020.109064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/18/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
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Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack within the Anterior Circulation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7056056. [PMID: 32149125 PMCID: PMC7049427 DOI: 10.1155/2020/7056056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022]
Abstract
Purpose The aim of the present study was to evaluate the relationship of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) with haemodynamic abnormality and severity of arterial stenosis in patients with transient ischemic attack (TIA) of the carotid artery system. Patients and Methods. Consecutive inpatients (N = 38) diagnosed with TIAs of the carotid system in a 4-year period (2014–2017) were retrospectively analysed in our study and divided into FVH-negative and FVH-positive groups based on the presence of FVH sign. Each inpatient had undergone magnetic resonance imaging (MRI) followed by computed tomography (CT) perfusion imaging studies. We investigated the degree of arterial stenosis, number of stenosis, watershed regions, and related CT perfusion indexes, including hypoperfusion regions, mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). Spearman rank correlation was performed between FVHs score, the degree of arterial stenosis, and CT perfusion indexes with significant difference. Results Thirty-one patients (81.6%) observed with FVH sign were assigned to the FVH-positive group. The hypoperfusion regions, MTT, and CBF values were significantly different between the FVH-negative group and FVH-positive groups. Spearman correlation analysis showed significant positive correlations between hypoperfusion regions, MTT, and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores ( Conclusion Hyperintense vessels on FLAIR were closely associated with hypoperfused regions, MTT, and CBF values, which indicated that the presence of FVHs could be an important and convenient imaging marker of haemodynamic impairment in patients with TIA.
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Wang F, Hu XY, Wang T, Fang XM, Dai Z, Guo DL, Mao XQ, Cui ZM. Clinical and imaging features of vertebrobasilar dolichoectasia combined with posterior circulation infarction: A retrospective case series study. Medicine (Baltimore) 2018; 97:e13166. [PMID: 30508895 PMCID: PMC6283110 DOI: 10.1097/md.0000000000013166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to analyze the clinical and imaging features of vertebrobasilar dolichoectasia (VBD) combined with posterior circulation infarction, and to explore risk factors for the occurrence of posterior circulation infarction in VBD patients.VBD patients were divided into 2 groups, according to the results of the imaging examination: posterior circulation infarction group and nonposterior circulation infarction group. The demographics, vascular risk factors, imaging, and other clinical data of the VBD patients were collected and retrospectively compared, and the risk factors for the occurrence of posterior circulation infarction in VBD patients were analyzed. The relationship between imaging features of the VBD blood supply artery and the infarct site was also analyzed.A total of 56 VBD patients were included into the analysis. Among these patients, 26 patients had posterior circulation infarction. Infarction occurred in the blood supply area of the posterior cerebral artery in 14 patients. The difference in the height of the basilar artery bifurcation between patients with vertebrobasilar artery blood supply area infarction and patients with posterior cerebral artery supply area infarction was statistically significant. Hypertension and posterior circulation intracranial atherosclerosis were the risk factors for posterior circulation infarction in VBD patients.Elevated basilar artery bifurcation is a risk factor for infarction in the posterior cerebral artery supply area in VBD patients. Posterior circulation infarction in VBD may be the comprehensive result of multiple factors, such as congenital defects of the basilar artery wall, hypertension, and atherosclerotic lesions.
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Affiliation(s)
| | - Xiao-Yun Hu
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | | | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | | | | | | | - Zhi-Ming Cui
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Peng YF, Zhang HL, Zhang DP, Zhao M, Zhang SL, Yin S. Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo. Ann Clin Transl Neurol 2018; 5:1562-1573. [PMID: 30564622 PMCID: PMC6292190 DOI: 10.1002/acn3.665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate the association between the perfusion magnetic resonance imaging (MRI) and vertebrobasilar dolichoectasia (VBD) in vertigo patients and at least one vascular risk factor. Methods We studied 289 patients with vertigo (spinning, swaying, nausea, vomiting, and unsteady gait) who performed multimode MRI. Maximum diameter and tortuous parameters of the basilar artery and vertebral arteries were calculated using magnetic resonance angiography. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), mean transit time (MTT), and time to peak (TTP) maps were evaluated by dynamic susceptibility contrast‐enhanced perfusion imaging. Association of perfusion MRI and VBD was evaluated by nonparametric tests and receiver‐operating characteristic curve was constructed to predict posterior ischemic stroke in VBD patients. Results The prevalence of VBD was 26.6% (n = 77/289) in our study. Male gender was the risk factor of VBD by multivariate analysis. BA diameter was significant statistics between ischemic stroke and nonischemic stroke patients. TTP in bilateral lower cerebellum, superior cerebellum, bilateral pons, and occipital and temporal lobes region of interests was significantly delayed in VBD versus non‐VBD patients, while rCBF, rCBV, and MTT parameters were not significant differences. TTP in the right temporal lobe delayed by 21.96 ms was the best predictive value and the mean TTP predictive threshold value in all ROIs was 22.67 ± 1.48 ms. Interpretation VBD leads to the hypoperfusion of posterior circulation territory characterized by delayed TTP. Delayed TTP in cerebellum, pons, and occipital and temporal lobes fed by vertebrobasilar arteries predicted the occurrence of posterior ischemic stroke in VBD patients.
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Affiliation(s)
- Yan Fang Peng
- Department of Neurology People's Hospital of Zhengzhou Affiliated to Southern Medical University Zhengzhou China
| | - Huai Liang Zhang
- Department of Neurology The First Affiliated Hospital of Henan University of CM Zhengzhou China
| | - Dao Pei Zhang
- Department of Neurology People's Hospital of Zhengzhou Affiliated to Southern Medical University Zhengzhou China.,Department of Neurology The First Affiliated Hospital of Henan University of CM Zhengzhou China
| | - Min Zhao
- Department of Neurology The First Affiliated Hospital of Henan University of CM Zhengzhou China
| | - Shu Ling Zhang
- Department of Neurology People's Hospital of Zhengzhou Affiliated to Southern Medical University Zhengzhou China
| | - Suo Yin
- Department of Image People's Hospital of Zhengzhou Affiliated to Southern Medical University Zhengzhou China
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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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Zhang DP, Peng YF, Ma QK, Zhao M, Zhang HL, Yin S. Why does my patient's basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia. BMC Neurol 2018; 18:45. [PMID: 29678166 PMCID: PMC5910553 DOI: 10.1186/s12883-018-1045-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vertebrobasilar dolichoectasia (VBD) is a clinical entity associated with ischemic stroke, compression of cranial nerves or brainstem, and hydrocephalus. There have been relatively few studies following the progression of VBD in patients presenting with a variety of diverse clinical features. CASE PRESENTATION Here, we report a case study of a male with progressive VBD who was followed from November 2012 to December 2016. The patient had diagnosed hypertension for several years and suffered from left peripheral facial paralysis, recurrent ischemic attacks in the brainstem and cerebellum, obstructive hydrocephalus and frequent pneumonia. A series of cranial CT and multi-modal MRI scans were performed to explore the brain imaging features of the patient during follow-up. CONCLUSIONS The presented case study suggests that aging, uncontrolled hypertension, arterial dissection and infection may contribute to the exacerbation of VBD and recurrent ischemic stroke.
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Affiliation(s)
- Dao Pei Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou Affiliated to Southern Medical University, Zhengzhou, China
| | - Yan Fang Peng
- Department of Neurology, People’s Hospital of Zhengzhou Affiliated to Southern Medical University, Zhengzhou, China
| | - Qian Kun Ma
- Department of Neurology, People’s Hospital of Henan Province, Zhengzhou, China
| | - Min Zhao
- Department of Neurology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, China
| | - Huai Liang Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, China
| | - Suo Yin
- Department of Image, People’s Hospital of Zhengzhou Affiliated to Southern Medical University, Zhengzhou, China
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Förster A, Wenz R, Maros ME, Böhme J, Al-Zghloul M, Alonso A, Groden C, Wenz H. Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia. PLoS One 2018; 13:e0196149. [PMID: 29672624 PMCID: PMC5908155 DOI: 10.1371/journal.pone.0196149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/07/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Vertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy associated with intracerebral hemorrhage. In the present study, we sought to evaluate the frequency and anatomical distribution of cerebral microbleeds (cMBs) and intracerebral hemorrhage (ICH) in VBD. METHODS From a MRI database 94 VBD patients were identified and analyzed with special emphasis on cMBs and ICH on T2*-weighted gradient echo images (GRE) in relation to the established diagnostic MRI criteria of VBD (diameter, height, and lateral position). cMBs/ICH location was categorized into anterior/posterior circulation. Clinical information like demographic details, clinical symptoms, and comorbidities were abstracted from the case records. An extensive modelling approach using generalized linear mixed-effects models was used. RESULTS Overall, 79 (84.0%) patients (mean age 72.1±10.0 years, 74.7% male) with a standard stroke MRI protocol including T2*-weighted images were included in the analysis. cMBs were observed in 38/79 (48.1%) patients, ranging from 1 to 84 cMBs per patient. In the posterior circulation cMBs were observed more frequently (34/38 (89.5%)) in comparison to the anterior circulation (24/38 (63.2%)). cMBs were observed in the thalamus in 20/38 (52.6%), hippocampus in 1/38 (2.6%), occipital lobe in 18/38 (47.4%), pons in 6/38 (15.8%), medulla oblongata in 2/38 (5.2%), and cerebellum in 14/38 (36.8%) patients. ICH was observed in only 6/79 (7.6%) patients. There were significantly more cMBs in the posterior- (NCMBs-PC = 1.717, 95%CI: 1.336-2.208, p = 0.0315) than in the anterior circulation. Logistic regression model showed a significant positive effect of clinical symptoms such as ischemic, TIA and hemorrhagic stroke on the presence of cMBs (OR = 3.34, 95%CI [2.0-5.57], p = 0.0184; ndf = 78, AIC = 107.51). General linear model showed that clinical symptoms have a highly significant effect on the number of cMBs (N = 2.78, 95%CI [2.51-3.07], p<2*10-16; ndf = 78, AIC = 1218). CONCLUSION cMBs and ICH may be observed in the anterior and posterior circulation in VBD but they occur more frequently in the posterior circulation. Most common anatomical locations of cMBs in VBD were the thalamus, occipital lobe and cerebellum. This posterior dominance of cMBs and ICH in VBD might reflect a specific underlying vascular pathology.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf Wenz
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Máté Elöd Maros
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- * E-mail:
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Li CC, Hao XZ, Tian JQ, Yao ZW, Feng XY, Yang YM. Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores. Neural Regen Res 2018; 13:69-76. [PMID: 29451209 PMCID: PMC5840994 DOI: 10.4103/1673-5374.224375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days (National Institutes of Health Stroke Scale) and 90 days (modified Rankin Scale) to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.
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Affiliation(s)
- Chan-Chan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Zhu Hao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Qi Tian
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-Wei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yuan Feng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan-Mei Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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12
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Gawlitza M, Böhme J, Maros M, Lobsien D, Michalski D, Groden C, Hoffmann KT, Förster A. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia. PLoS One 2017; 12:e0172570. [PMID: 28234996 PMCID: PMC5325299 DOI: 10.1371/journal.pone.0172570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess FLAIR vascular hyperintensities (FVH) and dynamic (4D) angiograms derived from perfusion raw data as proposed magnetic resonance (MR) imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA). METHODS Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified. RESULTS Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9) ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7) ml. FVH were observed in 26/41 (63.4%) hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01) absolute (ρ = 0.37; P<0.05) and relative mismatch volume (ρ = 0.35; P<0.05). The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01) and positively with relative mismatch (ρ = 0.29; P< 0.05). ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001) and TTP lesion volumes (P<0.05). No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32). CONCLUSIONS FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.
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Affiliation(s)
- Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maté Maros
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Samim M, Goldstein A, Schindler J, Johnson MH. Multimodality Imaging of Vertebrobasilar Dolichoectasia: Clinical Presentations and Imaging Spectrum. Radiographics 2016; 36:1129-46. [PMID: 27315445 DOI: 10.1148/rg.2016150032] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vertebrobasilar dolichoectasia (VBD) is characterized by ectasia, elongation, and tortuosity of the vertebrobasilar arteries, with a high degree of variability in clinical presentation. The disease origin is believed to involve degeneration of the internal elastic lamina, thinning of the media secondary to reticular fiber deficiency, and smooth muscle atrophy. The prevalence of VBD is variable, ranging from 0.05% to 18%. Most patients with VBD are asymptomatic and their VBD is detected incidentally; however, it is important to recognize that the presence of symptoms, which can lead to clinically significant morbidity and sometimes mortality, may influence clinical management. The most important clinical presentations of VBD are vascular events, such as ischemic stroke and catastrophic intracranial hemorrhage, or progressive compressive symptoms related to compression of adjacent structures, including the cranial nerves, brainstem, or third ventricle, causing hydrocephalus. The imaging diagnostic criteria for computed tomography and magnetic resonance (MR) imaging include three quantitative measures of basilar artery morphology: laterality score, height of bifurcation, and basilar artery diameter. The authors review the relevant anatomy and disease origin of VBD; pertinent imaging findings, including intraluminal thrombus and relation to the cranial nerves; and imaging pitfalls, such as the hyperintense vessel sign on MR images and artifacts related to slow flow in the dolichoectatic vessel. In addition, clinical manifestations, the role of radiology in diagnosis and management of this condition, and available management options are reviewed. (©)RSNA, 2016.
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Affiliation(s)
- Mohammad Samim
- From the Departments of Diagnostic Radiology (M.S., A.G., M.H.J.) and Neurology (J.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510
| | - Alan Goldstein
- From the Departments of Diagnostic Radiology (M.S., A.G., M.H.J.) and Neurology (J.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510
| | - Joseph Schindler
- From the Departments of Diagnostic Radiology (M.S., A.G., M.H.J.) and Neurology (J.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510
| | - Michele H Johnson
- From the Departments of Diagnostic Radiology (M.S., A.G., M.H.J.) and Neurology (J.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510
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