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Bu J, Han X, Wu Y, Lv H, Feng X, Gao D. Correlation between asymmetrical vein sign of SWI and long-term clinical outcomes in patients with middle cerebral artery ischemic stroke. Jpn J Radiol 2024:10.1007/s11604-024-01596-2. [PMID: 38805116 DOI: 10.1007/s11604-024-01596-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To evaluate the association of asymmetrical cortical vein sign (ACVS) and asymmetrical medullary vein sign (AMVS) on susceptibility-weighted imaging (SWI) with 90-day poor outcomes in patients with unilateral middle cerebral artery acute ischemic stroke (AIS) after conservative drug treatment. METHODS Clinical data for the participants included age, sex, smoking, alcohol, hypertension, diabetes, hyperlipidemia, coronary heart disease, NHISS-admission, and NHISS-discharge scores. Participants underwent magnetic resonance imaging (MRI) within 12 h of hospital admission, including conventional scan sequences and a SWI sequence. Poor prognosis was defined as a modified Rankin scale (mRS) ≥ 3 at 90 days. RESULTS A total of 108 patients were included from January 2021 to March 2022. Twenty-seven (25%) patients had a poor outcome at 90 days. Univariate analysis indicated that diabetes, NHISS-admission, NHISS-discharge, DWI-ASPECTS, SWI-ASPECTS, FLAIR-ASPECTS, and AMVS + were associated with 90-day poor outcome. Multivariate regression analysis showed that AMVS + was associated with 90-day poor outcome from the three models (OR = 3.57, P = 0.006; OR = 3.74, P = 0.005; OR = 5.14, P = 0.0057). However, no significant association was found between ACVS + and 90-day poor outcome. CONCLUSIONS AMVS might be a helpful neuroimaging predictor for poor outcome at 90 days compared to ACVS in drug-conserving treatment of patients with unilateral middle cerebral artery ischemic stroke.
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Affiliation(s)
- Jingying Bu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuefang Han
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Yankai Wu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Huandi Lv
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuran Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Duo Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China.
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Jung YH, Park M, Joo B, Suh SH, Lee K, Ahn SJ. Prominent cerebral veins on susceptibility-weighted angiography in acute meningoencephalitis. Brain Behav 2023; 13:e3255. [PMID: 37721542 PMCID: PMC10636387 DOI: 10.1002/brb3.3255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND PURPOSE We have commonly observed prominent cerebral veins on susceptibility-weighted angiography (SWAN) in acute meningoencephalitis. This study aimed to investigate the clinical significance of these findings. METHODS Cerebral veins on SWAN of 98 patients with acute meningoencephalitis diagnosed from February 2016 through October 2020 were classified into three groups according to the degree of venous prominence (mild, 23; moderate, 53; and prominent, 22). Clinical variables and laboratory findings were compared between these groups. The influence of variables on the prediction of prominent cerebral veins was measured by random forest (RF) and gradient boosting machine (GBM). RESULTS As cerebral veins became more prominent, cerebrospinal fluid (CSF) glucose level decreased (69.61 ± 29.05 vs. 59.72 ± 22.57 vs. 48.36 ± 20.29 mg/dL, p = .01) and CSF protein level increased (100.73 ± 82.98 vs. 104.73 ± 70.99 vs. 159.12 ± 118.15 mg/dL, p = .03). The etiology of meningoencephalitis, neurological symptoms, and increased intracranial pressure (ICP) signs differed between groups (p < .05). RF and GBM demonstrated that CSF protein level was the variable with the highest power to predict the prominent cerebral vein (mean decrease in node impurity: 4.19, relative influence: 50.66). CONCLUSION The presence of prominent cerebral veins on SWAN in acute meningoencephalitis was significantly associated with a low CSF glucose level and a high CSF protein level, as well as ICP. Thus, the visual grade of the cerebral veins on SWAN may be utilized for the management of patients with acute meningoencephalitis.
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Affiliation(s)
- Yo Han Jung
- Department of Neurology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Kyung‐Yul Lee
- Department of Neurology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
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Xu Y, Yao Y, Pylypenko D, Xu X, Li S, Wang Q. Diagnosis of pelvic endometriosis: a preliminary study on the added value of R2*MFGRE sequence in magnetic resonance imaging. Acta Radiol 2023; 64:1255-1262. [PMID: 35938205 DOI: 10.1177/02841851221117260] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying and locating endometriotic lesions is crucial for preoperative planning, so new magnetic resonance imaging (MRI) techniques are urgently needed to improve the diagnostic sensitivity for pelvic endometriosis. PURPOSE To evaluate the feasibility of R2* multiple fast gradient recalled echo (MFGRE) imaging in the diagnosis of pelvic endometriosis. MATERIAL AND METHODS A total of 46 patients with suspected endometriosis underwent routine pelvic MRI and R2*MFGRE imaging. Clinical diagnosis was pathologically confirmed one month after MRI examination. Three radiologists who were blinded to the pathological results evaluated the number of ovarian endometriomas (OMAs) and deep infiltrating endometriosis (DIE) lesions using routine MRI and its combination with R2*MFGRE. The diagnostic sensitivity for OMA or DIE using the two examination methods was determined. Two-correlation sample rank-sum tests were used to compare both methods. Additionally, for all lesions, the R2* values were measured and statistically analyzed. RESULTS Among 46 patients, 47 OMAs and 30 DIE lesions were found surgically and pathologically confirmed. The diagnostic sensitivity of the routine MRI was 87.2% for OMA and 46.7% for DIE. The diagnostic sensitivity of the routine imaging combined with R2*MFGRE was 100% for OMA and 90% for DIE. The two-correlation sample rank-sum test showed a significant difference between both methods (P<0.01, z = -4.26). The median R2* value was 25.20 (IQR=14) for the OMA group, and 45.21 (IQR=40) for the DIE group. The difference between both groups was statistically significant (P<0.01, z = -4.89). CONCLUSION R2*MFGRE imaging, as a supplement to the routine MRI, could improve the diagnostic sensitivity for pelvic endometriosis, especially for DIE.
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Affiliation(s)
- Yifan Xu
- Department of Radiology, 66310The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, PR China
| | - Yuan Yao
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | | | - Xinghua Xu
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | - Shuyi Li
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | - Qing Wang
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
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Meng Y, Zhang Y, Chu X, Song Y, Zhao W, Zheng M, Zhang J, Han J. Plaque modification and stabilization after drug-coated balloon angioplasty for intracranial atherosclerotic lesions. Eur Radiol 2023; 33:1112-1120. [PMID: 36136108 DOI: 10.1007/s00330-022-09129-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). We aimed to evaluate changes of vessel wall features of ICAD lesions after DCB treatment by using vessel wall MRI (VWMRI). METHODS We retrospectively included patients with symptomatic ICAD who underwent DCB angioplasty alone. The incidences of stenosis of the lumen area, vessel wall thickening, hyperintense plaques, and prominent wall enhancement were compared between the baseline and follow-up VWMRI. RESULTS There were 29 ICAD lesions from 29 patients, of which 22 were stenosis and 7 were occlusion. The median interval between DCB treatment and follow-up VWMRI was 4.1 [3.3, 6.7] months. After DCB treatment, follow-up VWMRI showed a significant decrease in the stenosis degree of the lumen area (83% [71%, 96%] vs 15% [3%, 41%], p < 0.001). Thirty-eight percent (11/29) of the patients observed normal appearance of the target vessel wall on follow-up VWMRI. In the stenosis group, the prevalence of hyperintense plaques decreased from 66.7% (14/21) at baseline to 23.8% (5/21) at follow-up, and prominent wall enhancement decreased from 66.7% (14/21) at baseline to 19.0%(4/21) at follow-up. The incidence of hyperintense plaques (p = 0.028) and vessel wall thickening (p = 0.018) tended to decrease with follow-up time. Although not significant (p = 0.106), a similar trend was observed between the incidence of prominent wall enhancement and follow-up time. CONCLUSION Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions. KEY POINTS • A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). • Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions.
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Affiliation(s)
- Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yuyan Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Xi Chu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yun Song
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Wei Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Meimei Zheng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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Huang K, Liu J, Yun W, Cao Y, Zhang M. The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients. Front Neurol 2022; 13:860824. [PMID: 36046632 PMCID: PMC9420992 DOI: 10.3389/fneur.2022.860824] [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: 01/23/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background and purpose Asymmetrical prominent veins sign (APVS) often appears on susceptibility-weighted angiography (SWAN) images in patients with acute stroke. Early neurological deterioration (END) is highly correlated with survival prognosis in patients with ischemic stroke. This study sought to explore the relationship between APVS and END in patients with acute stroke. Methods The subjects retrospectively enrolled in this study were patients with acute ischemic stroke in the middle cerebral artery supply area. All patients underwent head MRI, including the SWAN sequence, within 7 days of stroke symptom onset. END was defined as clinical deterioration or recurrence within 72 h after ischemic stroke. The volume of infarction on diffusion-weighted imaging was measured. Univariate and multivariate analyses were used to analyze the relationship between APVS and END. Spearman correlation between APVS grades and infarct volume, white matter hyperintensity (WMH) volume, and offending vessel were also analyzed. Results A total of 157 patients with middle cerebral artery infarct between September 2018 and April 2020 were included in the study. APVS appeared on MRI in 84 of 157 patients, and 34 of 157 patients were diagnosed with END. In patients with END, the proportion of severe APVS was higher than in patients without END (P = 0.001, x2 = 14.659). Patients with END were older and had a larger volume of infarct and WMH than patients without END (all P < 0.05). After adjustments were made for related risk factors of END, the severity of APVS was still related to END (OR = 2.56, 95% CI, 1.38–4.75; P for trend = 0.003). Spearman correlation showed that APVS grades were positively related to infarct volume (r = 0.289, P < 0.001) and 3-month modified Rankin Scale score (r = 0.203, P = 0.011) and negatively related to offending vessels (r = −0.170, P = 0.034). Conclusion APVS may be an important predictor of END in patients with acute ischemic stroke.
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Affiliation(s)
| | - Jianfang Liu
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yin Cao
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
- Yin Cao
| | - Min Zhang
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
- *Correspondence: Min Zhang
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Uchida Y, Kan H, Sakurai K, Oishi K, Matsukawa N. Quantitative susceptibility mapping as an imaging biomarker for Alzheimer’s disease: The expectations and limitations. Front Neurosci 2022; 16:938092. [PMID: 35992906 PMCID: PMC9389285 DOI: 10.3389/fnins.2022.938092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common type of dementia and a distressing diagnosis for individuals and caregivers. Researchers and clinical trials have mainly focused on β-amyloid plaques, which are hypothesized to be one of the most important factors for neurodegeneration in AD. Meanwhile, recent clinicopathological and radiological studies have shown closer associations of tau pathology rather than β-amyloid pathology with the onset and progression of Alzheimer’s symptoms. Toward a biological definition of biomarker-based research framework for AD, the 2018 National Institute on Aging–Alzheimer’s Association working group has updated the ATN classification system for stratifying disease status in accordance with relevant pathological biomarker profiles, such as cerebral β-amyloid deposition, hyperphosphorylated tau, and neurodegeneration. In addition, altered iron metabolism has been considered to interact with abnormal proteins related to AD pathology thorough generating oxidative stress, as some prior histochemical and histopathological studies supported this iron-mediated pathomechanism. Quantitative susceptibility mapping (QSM) has recently become more popular as a non-invasive magnetic resonance technique to quantify local tissue susceptibility with high spatial resolution, which is sensitive to the presence of iron. The association of cerebral susceptibility values with other pathological biomarkers for AD has been investigated using various QSM techniques; however, direct evidence of these associations remains elusive. In this review, we first briefly describe the principles of QSM. Second, we focus on a large variety of QSM applications, ranging from common applications, such as cerebral iron deposition, to more recent applications, such as the assessment of impaired myelination, quantification of venous oxygen saturation, and measurement of blood– brain barrier function in clinical settings for AD. Third, we mention the relationships among QSM, established biomarkers, and cognitive performance in AD. Finally, we discuss the role of QSM as an imaging biomarker as well as the expectations and limitations of clinically useful diagnostic and therapeutic implications for AD.
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Affiliation(s)
- Yuto Uchida
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Yuto Uchida,
| | - Hirohito Kan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Ōbu, Japan
| | - Kenichi Oishi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Noriyuki Matsukawa,
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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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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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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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Bhattacharjee R, Gupta RK, Das B, Dixit VK, Gupta P, Singh A. Penumbra quantification from MR SWI-DWI mismatch and its comparison with MR ASL PWI-DWI mismatch in patients with acute ischemic stroke. NMR IN BIOMEDICINE 2021; 34:e4526. [PMID: 33880799 DOI: 10.1002/nbm.4526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
In acute-ischemic-stroke patients, penumbra assessment plays a significant role in treatment outcome. MR perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) mismatch ratio can provide penumbra assessment. Recently reported studies have shown the potential of susceptibility-weighted imaging (SWI) in the qualitative assessment of penumbra. We hypothesize that quantitative penumbra assessment using SWI-DWI can provide an alternative to the PWI-DWI approach and this can also reduce the overall scan-time. The purpose of the current study was to develop a framework for accurate quantitative assessment of penumbra using SWI-DWI and its validation with PWI-DWI-based quantification. In the current study, the arterial-spin-labelling (ASL) technique has been used for PWI. This retrospective study included 25 acute-ischemic-stroke patients presenting within 24 hours of the last noted baseline condition of stroke onset. Eleven patients also had follow-up MRI within 48 hours. MRI acquisition comprised DWI, SWI, pseudo-continuous-ASL (pCASL), FLAIR and non-contrast-angiography sequences. A framework was developed for the enhancement of prominent hypo-intense vein signs followed by automatic segmentation of the SWI penumbra ROI. Apparent-diffusion-coefficient (ADC) maps and cerebral-blood-flow (CBF) maps were computed. The infarct core ROI from the ADC map and the ASL penumbra ROI from CBF maps were segmented semiautomatically. The infarct core volume, SWI penumbra volume (SPV) and pCASL penumbra volume were computed and used to calculate mismatch ratios MRSWIADC and MRCBFADC . The Dice coefficient between the SWI penumbra ROI and ASL penumbra ROI was 0.96 ± 0.07. MRSWIADC correlated well (r = 0.90, p < 0.05) with MRCBFADC , which validates the hypothesis of accurate penumbra assessment using the SWI-DWI mismatch ratio. Moreover, a significant association between high SPV and the presence of vessel occlusion in the MR angiogram was observed. Follow-up data showed salvation of penumbra tissue (location and volumes predicted by proposed framework) by treatments. Additionally, functional-outcome analysis revealed 93.3% of patients with MRSWIADC > 1 benefitted from revascularization therapy. Overall, the proposed automated quantitative assessment of penumbra using the SWI-DWI mismatch ratio performs equivalently to the ASL PWI-DWI mismatch ratio. This approach provides an alternative to the perfusion sequence required for penumbra assessment, which can reduce scan time by 17% for the protocol without a perfusion sequence.
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Affiliation(s)
- Rupsa Bhattacharjee
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Philips Health System, Philips India Limited, Gurugram, India
| | - Rakesh Kumar Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurugram, India
| | - Biplab Das
- Department of Interventional Neuroradiology, Fortis Memorial Research Institute, Gurugram, India
- Department of Neurology, Fortis Memorial Research Institute, Gurugram, India
| | - Vijay Kant Dixit
- Department of Interventional Neuroradiology, Fortis Memorial Research Institute, Gurugram, India
| | - Praveen Gupta
- Department of Neurology, Fortis Memorial Research Institute, Gurugram, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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11
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Aker L, Abandeh L, Abdelhady M, Aboughalia H, Vattoth S. Susceptibility-weighted Imaging in Neuroradiology: Practical Imaging Principles, Pearls and Pitfalls. Curr Probl Diagn Radiol 2021; 51:568-578. [PMID: 34210556 DOI: 10.1067/j.cpradiol.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023]
Abstract
Susceptibility-weighted imaging (SWI) was one of the recent and helpful advancement in magnetic resonance imaging. Its utilization -provided valuable information for the radiologists in multiple fields, including neuroradiology. SWI was able to demonstrate cerebral paramagnetic and diamagnetic substances. Therefore, the applications of this imaging technique were diverse in research and clinical neuroradiology. This article reviewed the basic technical steps, various clinical applications of SWI, and potential limitations. The practicing radiologist needs to be oriented about using SWI and phase images in the right- and left-handed MRI systems to demonstrate different brain pathologies, including neurovascular diseases, traumatic brain injuries, brain tumors, infectious and inflammatory, and neurodegenerative diseases.
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Affiliation(s)
- Loai Aker
- Department of Clinical Imaging, Hamad Medical Corporation,Doha,Qatar.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle,WA
| | | | - Hassan Aboughalia
- Radiology Department, Seattle Children's Hospital, University of Washington Medical Center,Seattle,WA
| | - Surjith Vattoth
- Neuroradiology Section, University of Arkansas for Medical Sciences (UAMS),Little Rock,AR
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12
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Shi GZ, Chen H, Zeng WK, Gao M, Wang MZ, Zhang HT, Shen J. R2* value derived from multi-echo Dixon technique can aid discrimination between benign and malignant focal liver lesions. World J Gastroenterol 2021; 27:1182-1193. [PMID: 33828393 PMCID: PMC8006098 DOI: 10.3748/wjg.v27.i12.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND R2* estimation reflects the paramagnetism of the tumor tissue, which may be used to differentiate between benign and malignant liver lesions when contrast agents are contraindicated.
AIM To investigate whether R2* derived from multi-echo Dixon imaging can aid differentiating benign from malignant focal liver lesions (FLLs) and the impact of 2D region of interest (2D-ROI) and volume of interest (VOI) on the outcomes.
METHODS We retrospectively enrolled 73 patients with 108 benign or malignant FLLs. All patients underwent conventional abdominal magnetic resonance imaging and multi-echo Dixon imaging. Two radiologists independently measured the mean R2* values of lesions using 2D-ROI and VOI approaches. The Bland–Altman plot was used to determine the interobserver agreement between R2* measurements. Intraclass correlation coefficient (ICC) was used to determine the reliability between the two readers. Mean R2* values were compared between benign and malignant FFLs using the nonparametric Mann–Whitney test. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of R2* in differentiation between benign and malignant FFLs. We compared the diagnostic performance of R2* measured by 2D-ROI and VOI approaches.
RESULTS This study included 30 benign and 78 malignant FLLs. The interobserver reproducibility of R2* measurements was excellent for the 2D-ROI (ICC = 0.994) and VOI (ICC = 0.998) methods. Bland–Altman analysis also demonstrated excellent agreement. Mean R2* was significantly higher for malignant than benign FFLs as measured by 2D-ROI (P < 0.001) and VOI (P < 0.001). The area under the curve (AUC) of R2* measured by 2D-ROI was 0.884 at a cut-off of 25.2/s, with a sensitivity of 84.6% and specificity of 80.0% for differentiating benign from malignant FFLs. R2* measured by VOI yielded an AUC of 0.875 at a cut-off of 26.7/s in distinguishing benign from malignant FFLs, with a sensitivity of 85.9% and specificity of 76.7%. The AUCs of R2* were not significantly different between the 2D-ROI and VOI methods.
CONCLUSION R2* derived from multi-echo Dixon imaging whether by 2D-ROI or VOI can aid in differentiation between benign and malignant FLLs.
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Affiliation(s)
- Guang-Zi Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
| | - Hong Chen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
| | - Wei-Ke Zeng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
| | - Ming Gao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
| | - Meng-Zhu Wang
- MR Scientific Marketing, Siemens Healthineers, Guangzhou 510120, Guangdong Province, China
| | - Hui-Ting Zhang
- MR Scientific Marketing, Siemens Healthineers, Guangzhou 510120, Guangdong Province, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
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13
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Wang X, Dou W, Dong D, Wang X, Chen X, Chen K, Mao H, Guo Y, Zhang C. Can 3D Pseudo-Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis? J Magn Reson Imaging 2021; 54:175-183. [PMID: 33615609 DOI: 10.1002/jmri.27560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Unilateral middle cerebral artery (MCA) stenosis, as an independent risk factor for stroke, requires an intervention operation for vessel recanalization. Accurate perfusion measurement is thus essential after the operation. PURPOSE To explore the feasibility of three-dimensional (3D) pseudo-continuous territorial arterial-spin-labeling (tASL) in evaluating MCA recanalization. STUDY TYPE Prospective and longitudinal. SUBJECTS Forty-seven patients with unilateral MCA stenosis or occlusion. FIELD STRENGTH/SEQUENCE A 3.0 T, 3D time-of-flight fast-field-echo magnetic resonance (MR) angiography sequence, spin-echo echo-planar diffusion-weighted imaging sequence, 3D fast-spin-echo pseudo-continuous ASL (pcASL) and tASL sequences. ASSESSMENT All patients underwent MR examination before and after MCA recanalization and scored using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admission and discharge. An mRS score <2 was defined as a good prognosis. 3D-pcASL and tASL cerebral blood flow (CBF) maps were obtained, and the corresponding Alberta Stroke Program Early CT Score (ASPECTS)-based scores were evaluated. STATISTICAL TESTS The Kolmogorov-Smirnov test, intra-class correlation coefficient, paired t-test, receiver operating characteristic (ROC) curve, and multivariable logistic regression analysis. RESULTS After recanalization, tASL derived absolute CBFs between the affected and contralateral sides were significantly higher than before the operation (mean: 34.3 ± 8.5 mL/100 g/min vs. 40.6 ± 9.2 mL/100 g/min, 42.6 ± 9.8 mL/100 g/min vs. 43.5 ± 9.9 mL/100 g/min, both P < 0.05). In ROC analysis, tASL provided good prognosis (area under ROC curve [AUC] = 0.829; 95% CI: 0.651-1.000, P < 0.05), while pcASL had lower prognostic value (AUC = 0.760; 95% CI: 0.574-0.946, P < 0.05). The NIHSS score before recanalization, pcASL, and tASL-based ASPECTS scores were significantly associated with good clinical outcome (P < 0.05). Multivariable analysis revealed that ASPECTS-based scores of pcASL and tASL before and after surgery were independent predictors of good clinical outcome (all P < 0.05). DATA CONCLUSION: tASL can determine hypoperfusion in the responsible vascular perfusion area and predict clinical outcome. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xinyu Wang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital), Jinan, Shandong Province, 250014, China.,Shandong First Medical University, Jinan, Shandong Province, 250000, China
| | - Weiqiang Dou
- MR Research, GE Healthcare, Beijing, 10076, China
| | - Dong Dong
- Shandong Qianfoshan Hospital, Cheeloo College of Medicine,Shandong University, Jinan, Shandong Province, 250014, China
| | - Xinyi Wang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital), Jinan, Shandong Province, 250014, China
| | - Xueyu Chen
- Shandong First Medical University, Jinan, Shandong Province, 250000, China
| | - Kunjian Chen
- Shandong First Medical University, Jinan, Shandong Province, 250000, China
| | - Huimin Mao
- Shandong First Medical University, Jinan, Shandong Province, 250000, China
| | - Yu Guo
- Shandong First Medical University, Jinan, Shandong Province, 250000, China
| | - Chao Zhang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital), Jinan, Shandong Province, 250014, China
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14
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Wang YR, Li ZS, Huang W, Yang HQ, Gao B, Chen YT. The Value of Susceptibility-Weighted Imaging (SWI) in Evaluating the Ischemic Penumbra of Patients with Acute Cerebral Ischemic Stroke. Neuropsychiatr Dis Treat 2021; 17:1745-1750. [PMID: 34113105 PMCID: PMC8184242 DOI: 10.2147/ndt.s301870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to discuss the value of susceptibility-weighted imaging (SWI) in evaluating the ischemic penumbra of patients with acute cerebral ischemic stroke. METHODS Data were collected from 52 patients with acute cerebral ischemic stroke upon clinical diagnosis and routine examinations of magnetic resonance imaging (MRI), including SWI, diffusion-weighted imaging (DWI), and perfusion-weighted imaging (PWI) within 72 hours after onset in this retrospective study. The methods also included fusing the DWI and SWI images and calculating the volume of anomaly extension of DWI and PWI-MTT (mean transit time) using semi-automatic analysis software. The SWI-DWI and PWI-DWI mismatches were interpreted, and the statistical analysis was completed. RESULTS The two physicians found that the ischemic penumbra consistency is high throughout the SWI-DWI and PWI-DWI mismatches, without a significant difference (P > 0.05). CONCLUSION SWI-DWI mismatch can prevent the injection of contrast agents and make an accurate diagnosis of acute stroke ischemic penumbra, which helps guide the selection of the clinical therapeutic plan.
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Affiliation(s)
- Yong-Ren Wang
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
| | - Zhao-Sheng Li
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
| | - Wei Huang
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
| | - Hui-Qiang Yang
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
| | - Bo Gao
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
| | - Yu-Ting Chen
- Department of Radiology, Chinese Medical Hospital of Yiwu, Yiwu, 322000, People's Republic of China
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15
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Chen CCV, Chang C, Lin MF, Huang GS, Chan WP. Acute ischemic stroke induces magnetic resonance susceptibility signs dominated by endothelial nitric oxide synthase activation. Magn Reson Med 2020; 85:2201-2211. [PMID: 33128486 DOI: 10.1002/mrm.28567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE Acute ischemic stroke induces deoxyhemoglobin accumulation around the ischemic region while activating endothelial nitric oxide synthase (eNOS) coupling and the subsequent release of nitric oxide (NO). Because deoxyhemoglobin is a natural NO spin trap, its interplay with NO could be prominent during acute stroke. Its interaction with NO has been shown to induce overt paramagnetic signals in vitro; our goal was to investigate whether this interplay can be detected using MRI. METHODS To verify the in vivo image effects using the deoxyhemoglobin-NO interaction during acute stroke, eNOS states were manipulated in an animal model of acute ischemia, and the susceptibility signals, cerebral perfusion, and infarction were assessed noninvasively via MR susceptibility weighted imaging (SWI). RESULTS Occlusion of the right middle cerebral artery increased eNOS coupling and susceptibility signals in the ischemic cortex while abolishing regional cerebral blood flow. Pharmacological eNOS blockage led to weakened susceptibility signals in the ischemic cortex as well as worsened tissue survival. Consistently, abolishment of eNOS coupling through genetic editing reduced the regional susceptibility signals in the ischemic cortex, causing large infarcts. CONCLUSION Upregulation of eNOS during acute ischemia sustains tissue viability through the interaction between NO and deoxyhemoglobin. This interplay can be traced in vivo using SWI and can be considered a sensitive marker revealing the delicate oxygenation status of the ischemic tissue, therefore, guiding the management of acute stroke in clinical settings.
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Affiliation(s)
| | - Chen Chang
- Institute of Biomedical Sciences, Academia Sinica, Taiwan
| | - Ming-Fang Lin
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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16
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Asymmetry of medullary veins on multiphase CT-angiography in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:105064. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
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17
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Liu YL, Xiao WM, Lu JK, Wang YZ, Lu ZH, Zhong HH, Qu JF, Fang XW, Liang MQ, Chen YK. Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke. Brain Behav 2020; 10:e01657. [PMID: 32436291 PMCID: PMC7375089 DOI: 10.1002/brb3.1657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) could predict 90-day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r-tPA). METHODS Clinical data of consecutive patients with anterior circulation AIS treated with r-tPA were retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, NIHSS score, onset to treatment time, and initial hematologic and neuroimaging findings. Follow-up was performed 90 days after onset. Poor outcome was defined as a modified Rankin scale (mRS) ≥3 at 90 days. RESULTS A total of 145 patients were included, 35 (24.1%) patients presented with ACVS (≥Grade 1) on SWI. Fifty-three (36.6%) patients had a poor outcome at 90 days. ACVS (≥Grade 1) occurred in 21 (39.6%) patients with poor outcome compared with 14 (15.2%) patients with favorable outcome (p = .001). Univariate analysis indicated that age, NIHSS score on admission, previous stroke, hemorrhagic transformation, severe intracranial large artery stenosis or occlusion (SILASO), and ACVS were associated with 90-day poor outcome (p < .05). Since SILASO and ACVS were highly correlated and ACVS had different grades, we used three logistic regression models. Results from the three models showed that ACVS was associated with 90-day poor outcome. CONCLUSIONS In r-tPA-treated patients with anterior circulation AIS, ACVS might be a helpful neuroimaging predictor for poor outcome at 90 days.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Jie-Kai Lu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Ya-Zhi Wang
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Zhi-Hao Lu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Xue-Wen Fang
- Department of Radiology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Man-Qiu Liang
- Department of Radiology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
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18
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Rai SP, Sanyal P, Pai S, Achappa B, Madi D, Mr P. Synergistic role of susceptibility-weighted imaging with diffusion-weighted imaging and magnetic resonance angiography in the evaluation of acute arterial stroke. J Int Med Res 2019; 47:2166-2176. [PMID: 30971155 PMCID: PMC6567791 DOI: 10.1177/0300060519840909] [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: 12/02/2022] Open
Abstract
Objective This study was performed to investigate whether diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are more effective than conventional imaging modalities for evaluation of stroke and selection of candidates for thrombolytic therapy. Methods Eighty patients who presented within 12 hours of onset of symptoms of brain ischemia underwent 1.5T magnetic resonance imaging. DWI and SWI were compared with conventional sequences (T1, T2, and fluid-attenuated inversion recovery [FLAIR]) and time-of-flight magnetic resonance angiography (TOF-MRA) to assess factors that affect stroke management and prognosis. Results The volume of brain tissue showing hyperintensity was significantly greater than that showing diffusion restriction in patients with a >6-hour symptom onset. The hypointensity sign (susceptibility sign) on SWI showed a sensitivity of 66.7%, specificity of 87.5%, positive predictive value of 88.9, and negative predictive value of 63.6 compared with TOF-MRA. Micro-hemorrhagic foci were significantly associated with 27-mL infarcts on DWI (sensitivity, 71.4%; specificity, 85.0%). Patients with DWI–SWI mismatch showed better responses to thrombolytics. FLAIR–DWI mismatch helped to assess the time of stroke onset. Conclusion DWI and SWI should be part of the routine imaging protocol in patients with acute stroke and serve as a decision-making tool for selection of patients for thrombolytic therapy.
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Affiliation(s)
- Santosh Pv Rai
- 1 Department of Radiodiagnosis, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pulastya Sanyal
- 1 Department of Radiodiagnosis, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivananda Pai
- 2 Department of Neurology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Basavaprabhu Achappa
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepak Madi
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pavan Mr
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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19
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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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20
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Ko HC, Ryu CW, Yun SJ, Koh JS, Shin HS, Kim EJ. Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date. Neurointervention 2018; 13:90-99. [PMID: 30196679 PMCID: PMC6132033 DOI: 10.5469/neuroint.2018.01039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Characteristic signs - the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) - on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy. MATERIALS AND METHODS We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed. RESULTS Nine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335-1.131 and OR, 0.993; 95% CI, 0.629-1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study. CONCLUSION Our meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
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Li L, Liu MS, Li GQ, Zheng Y, Guo TL, Kang X, Yuan MT. Susceptibility-weighted Imaging in Thrombolytic Therapy of Acute Ischemic Stroke. Chin Med J (Engl) 2018; 130:2489-2497. [PMID: 29052571 PMCID: PMC5684633 DOI: 10.4103/0366-6999.216401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke. Study Selection: Papers in English or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors’ files. Results: SWI is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign (SVS) on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectomy in combination or alone. SWI is sensitive in detecting cerebral microbleed (CMB), and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple foci could possibly be related to intracranial hemorrhage (ICH) after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions: It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
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Affiliation(s)
- Lin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Su Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Guang-Qin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yang Zheng
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Tong-Li Guo
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Xin Kang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Mao-Ting Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
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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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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: 55] [Impact Index Per Article: 7.9] [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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Payabvash S, Taleb S, Benson JC, Hoffman B, Oswood MC, McKinney AM, Rykken JB. Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications. Acta Radiol 2017; 58:876-882. [PMID: 27799573 DOI: 10.1177/0284185116675658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.
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Affiliation(s)
| | - Shayandokht Taleb
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - John C Benson
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Bateman M, Slater LA, Leslie-Mazwi T, Simonsen CZ, Stuckey S, Chandra RV. Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection. Top Magn Reson Imaging 2017; 26:77-82. [PMID: 28277459 DOI: 10.1097/rmr.0000000000000124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including extending the opportunity of reperfusion treatment to well beyond the current time-based treatment windows.This review examines the use of DWI and PWI in the major stroke trials, their current clinical utility, and potential limitations for reperfusion treatment selection. DWI and PWI continue to be investigated in ongoing randomized controlled trials, and continued research into these techniques will help achieve the goal of tissue-based decision making and individualized acute stroke treatment.
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Affiliation(s)
- Mathew Bateman
- *Neuroradiology Service, Monash Imaging, Monash Health †School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia ‡NeuroEndovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Liu S, Buch S, Chen Y, Choi HS, Dai Y, Habib C, Hu J, Jung JY, Luo Y, Utriainen D, Wang M, Wu D, Xia S, Haacke EM. Susceptibility-weighted imaging: current status and future directions. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3552. [PMID: 27192086 PMCID: PMC5116013 DOI: 10.1002/nbm.3552] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 05/14/2023]
Abstract
Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Saifeng Liu
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Sagar Buch
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Hyun-Seok Choi
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yongming Dai
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Charbel Habib
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Joon-Yong Jung
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yu Luo
- Department of Radiology, the Branch of Shanghai First Hospital, Shanghai, China
| | - David Utriainen
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - E. Mark Haacke
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
- Department of Radiology, Wayne State University, Detroit, MI, US
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
- Address correspondence to: E. Mark Haacke, Ph.D., 3990 John R Street, MRI Concourse, Detroit, MI 48201. 313-745-1395,
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Payabvash S, Benson JC, Taleb S, Rykken JB, Hoffman B, Oswood MC, McKinney AM. Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke. Br J Radiol 2017; 89:20160714. [PMID: 27805839 DOI: 10.1259/bjr.20160714] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke. METHODS Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined. RESULTS Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k = 0.314-0.338, p ≤ 0.001) for grading, and moderate agreement (k = 0.406-0.413, p ≤ 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho = 0.232, p = 0.001; rho = 0.180, p = 0.008; respectively) and larger infarct volume (rho = 0.445, p < 0.001; rho = 0.167, p = 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p = 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p < 0.001). CONCLUSION There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).
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Affiliation(s)
| | - John C Benson
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shayandokht Taleb
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
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Abstract
Susceptibility-weighted imaging (SWI) has become an important imaging sequence in the evaluation of patients with neurovascular disease. In this review, we provide a general overview of the physics of SWI and describe how image contrast is produced with this technique. We provide a general approach and differential diagnosis for 2 commonly encountered radiographic patterns seen with SWI in neurovascular disease. Finally, we discuss specific neurovascular applications of SWI, including its application in acute stroke, vascular malformations, venous thrombosis, and evaluation of cerebral microbleeds.
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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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Dejobert M, Cazals X, Annan M, Debiais S, Lauvin MA, Cottier JP. Susceptibility-Diffusion Mismatch in Hyperacute Stroke: Correlation with Perfusion-Diffusion Mismatch and Clinical Outcome. J Stroke Cerebrovasc Dis 2016; 25:1760-1766. [PMID: 27151417 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/18/2016] [Accepted: 02/19/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND A prominent vein (PV) on susceptibility-weighted imaging (SWI) was recently proposed to be a marker of the penumbra. We aimed to compare the utility of SWI and perfusion-weighted imaging (PWI) sequences for the evaluation of the penumbra in hyperacute middle cerebral artery (MCA) stroke, and to determine whether SWI-DWI mismatch is a neuroimaging marker of clinical outcome. METHODS A total of 149 consecutive patients with MCA stroke were prospectively enrolled. Magnetic resonance imaging (MRI) was performed within 6 hours of the onset of stroke. The ASPECTS values on diffusion-weighted imaging (DWI), PWI (delayed mean transit time), and SWI (visualization of PVs) were calculated by 2 independent raters. Correlation between PWI-ASPECTS and SWI-ASPECTS was calculated with the Pearson coefficient. Reliability of the PV rating system was calculated by an intraclass correlation coefficient (ICC). Favorable outcome was defined as a modified Rankin Scale score of 0-2 at 3 months for the 88 patients who received thrombolytic therapy. RESULTS The ASPECTS-SWI and ASPECTS-PWI scores showed a good correlation (Pearson coefficient of .69, P <.001). The reproducibility between the findings of the junior and the senior radiologists was excellent with an ICC of .89 (confidence interval of 95% (IC95): .85-.92, P <.001). However, neither SWI-DWI mismatch nor PWI-SWI mismatch was associated with clinical outcome. CONCLUSION SWI and PWI were complementary but not commutable for the assessment of the penumbra. Susceptibility-diffusion mismatch was not found in this study to have predictive value for stroke outcome.
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Affiliation(s)
- Maelle Dejobert
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France.
| | - Xavier Cazals
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France
| | - Mariam Annan
- Department of Neurology, Bretonneau University Hospital, Tours, France
| | - Séverine Debiais
- Department of Neurology, Bretonneau University Hospital, Tours, France
| | - Marie-Agnes Lauvin
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France
| | - Jean-Philippe Cottier
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France
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Yu X, Yuan L, Jackson A, Sun J, Huang P, Xu X, Mao Y, Lou M, Jiang Q, Zhang M. Prominence of Medullary Veins on Susceptibility-Weighted Images Provides Prognostic Information in Patients with Subacute Stroke. AJNR Am J Neuroradiol 2016; 37:423-9. [PMID: 26514606 PMCID: PMC7960117 DOI: 10.3174/ajnr.a4541] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/29/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE The demonstration of prominent medullary veins in the deep white matter ipsilateral to acute ischemic stroke has been shown to predict poor clinical outcome. We have investigated the prognostic implications of prominent medullary veins in patients with subacute stroke who present outside the therapeutic window for revascularization therapy. MATERIALS AND METHODS Forty-three consecutive patients with ischemic stroke in the middle cerebral artery territory presenting within 3-7 days of ictus were enrolled. The presence of prominent medullary veins in the periventricular white matter of the ipsilateral and contralateral medullary vein hemispheres was recorded. Perfusion-weighted imaging was used to calculate differences in hemispheric CBF from corresponding areas. Clinical outcome was classified as good if the modified Rankin Scale score was <3. RESULTS Prominent medullary veins were observed in 24/43 patients with 14 ipsilateral medullary veins and 10 contralateral medullary veins. The ipsilateral medullary vein was independently associated with poor outcome (odds ratio, 11.19; P = .046). The contralateral medullary vein was not independently predictive of outcome but was significantly more common in patients with good outcome (90.0% contralateral medullary veins). A mean 64.5% decrease and a 52.4% increase of differences in hemispheric CBF were found in ipsilateral medullary veins and contralateral medullary veins, respectively. CONCLUSIONS The ipsilateral medullary vein was a significant predictive biomarker of poor clinical outcome after stroke and was associated with hypoperfusion. The contralateral medullary vein was associated with good clinical outcome, and we hypothesize that prominent contralateral medullary veins indirectly reflect increased CBF in the ipsilateral hemisphere due to spontaneous recanalization or collateral flow.
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Affiliation(s)
- X Yu
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - L Yuan
- Department of Biomedical Engineering and Instrument Science (L.Y.), Key Laboratory for Biomedical Engineering of Education Ministry of China, Zhejiang University, Hangzhou, China
| | - A Jackson
- Wolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, United Kingdom
| | - J Sun
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - P Huang
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - X Xu
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
| | - Y Mao
- Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - M Lou
- Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Q Jiang
- Department of Neurology (Q.J.), Henry Ford Health System, Detroit, Michigan
| | - M Zhang
- From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.)
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Mundiyanapurath S, Ringleb PA, Diatschuk S, Burth S, Möhlenbruch M, Floca RO, Wick W, Bendszus M, Radbruch A. Cortical vessel sign on susceptibility weighted imaging reveals clinically relevant hypoperfusion in internal carotid artery stenosis. Eur J Radiol 2015; 85:534-9. [PMID: 26860664 DOI: 10.1016/j.ejrad.2015.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/30/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Internal carotid artery (ICA) stenosis can lead to cerebral hypoperfusion and is a common cause of stroke. As susceptibility weighted imaging (SWI) has been used for penumbra imaging in acute ischemic stroke, we aimed at analyzing hypoperfusion using SWI in patients with ICA stenosis. MATERIAL AND METHODS Clinical characteristics, asymmetric cortical vessel sign (more and/or larger, hypointense asymmetric cortical vessels) on SWI, Doppler sonography results and diffusion weighted imaging (DWI) lesion volume were retrospectively analyzed in patients with ICA stenosis. In a subgroup of patients, volume of prolonged time to peak and volume of prolonged time to peak of the residue curve (Tmax) were measured as reference standard. Outcome was assessed as modified Rankin score at discharge. RESULTS 104 patients were included. Median age was 72 and median degree of stenosis 70% according to NASCET. 13% had a asymmetric cortical vessel sign. These patients had a higher degree of stenosis (80% vs. 70%, p=0.004), were more often symptomatic (93% vs. 61%, p=0.020) and had higher DWI volume (7.3ml vs. 0.2ml, p=0.011). Specificity for the prediction of DWI lesions was 86%. Also, patients with asymmetric cortical vessel sign had lower rates of favorable outcome (mRS=0-2; 57% vs. 82%, p=0.033) and volumes of Tmax≥4s, ≥6s, ≥8s, ≥10s and TTP≥2s, ≥4s, ≥6s were significantly higher. In multivariate analysis, asymmetric cortical vessel sign was an independent negative predictor of favorable outcome (mRS 0-2; OR 0.184; CI [0.039; 0.875] p=0.033). CONCLUSION In patients with ICA stenosis, asymmetric cortical vessel sign is a sign of clinically relevant hypoperfusion.
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Affiliation(s)
- Sibu Mundiyanapurath
- Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Sascha Diatschuk
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany
| | - Sina Burth
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Ralf O Floca
- German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; CCU Neurooncology, German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), INF 280, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany
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Mundiyanapurath S, Möhlenbruch M, Ringleb PA, Bösel J, Wick W, Bendszus M, Radbruch A. Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score Using Hypointense Vessels on Susceptibility Weighted Imaging Independently Predicts Outcome in Patients with Basilar Artery Occlusion. PLoS One 2015; 10:e0132587. [PMID: 26176682 PMCID: PMC4503629 DOI: 10.1371/journal.pone.0132587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/16/2015] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Appearance of hypointense vessels on susceptibility weighted imaging (SWI) has been reported to correlate with outcome in patients with ischemia of the anterior circulation. This study investigates the correlation between the appearance of hypointense vessels on SWI after recanalization therapy and outcome in patients with basilar artery occlusion. METHODS Patients with basilar artery occlusion who were treated with endovascular recanalization or intravenous alteplase and received an MRI including SWI after therapy were retrieved from the hospital database for retrospective analysis. Posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pcASPECTS) was calculated based on regions displaying hypointense vessels on SWI and compared to lesions on diffusion weighted imaging (DWI). Subsequently, SWI based pcASPECTS was correlated with outcome determined with modified Rankin Scale (mRS), categorized as favorable outcome (mRS 0-2) or unfavorable outcome (3-6). RESULTS Twenty-two MRI of patients with basilar artery occlusion were analyzed. In seven out of eight areas of the pcASPECTS hypointense vessels on SWI were significantly correlated to areas of restricted diffusion on DWI. In univariate analysis median pcASPECTS on SWI was significantly higher in patients with favorable outcome (7.5 vs. 5, p=0.02). In a multivariate analysis pcASPECTS on SWI was an independent predictor of favorable outcome (OR 2.02; CI [1.02;3,99]; p=0.04). CONCLUSION pcASPECTS based on hypointense vessels on SWI after therapy predicts outcome in patients with basilar artery occlusion and might potentially be used as an additional imaging biomarker in the management of patients with stroke in the posterior circulation. This needs to be confirmed in larger prospective clinical trials.
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Affiliation(s)
- S. Mundiyanapurath
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - P. A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - J. Bösel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - W. Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A. Radbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center, Department of Radiology, Heidelberg, Germany
- * E-mail:
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Na DG, Sohn CH, Kim EY. Imaging-based management of acute ischemic stroke patients: current neuroradiological perspectives. Korean J Radiol 2015; 16:372-90. [PMID: 25741200 PMCID: PMC4347274 DOI: 10.3348/kjr.2015.16.2.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/02/2014] [Indexed: 01/05/2023] Open
Abstract
Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.
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Affiliation(s)
- Dong Gyu Na
- Department of Neuroradiology, Head & Neck Radiology, Thyroid Radiology Human Medical Imaging & Intervention Center, Seoul 137-902, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon 405-760, Korea
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Tang H, Zhang S, Yan S, Liebeskind DS, Sun J, Ding X, Zhang M, Lou M. Unfavorable neurological outcome in diabetic patients with acute ischemic stroke is associated with incomplete recanalization after intravenous thrombolysis. J Neurointerv Surg 2015; 8:342-6. [DOI: 10.1136/neurintsurg-2014-011643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/11/2015] [Indexed: 11/03/2022]
Abstract
ObjectiveTo assess the impact of diabetes on neurological outcome and recanalization in acute ischemic stroke (AIS) after intravenous thrombolysis (IVT).MethodsClinical data of 419 consecutive patients with AIS who received IVT between June 2009 and April 2014. Based on the medical history and new diagnosis, the patients were divided into groups with and without diabetes. Neurological outcomes at 24 h, 7 days and 3 months after IVT were evaluated. Favorable outcome was defined as National Institutes of Health Stroke Scale (NIHSS) score decrease ≥4 points from baseline or 0 at 24 h, NIHSS decrease ≥8 points or 0 at day 7, or modified Rankin scale ≤1 at 3 months after IVT. Recanalization on non-invasive imaging was evaluated in patients with large vessel occlusion (LVO) according to thrombolysis in myocardial infarction grades.ResultsAmong 419 patients, 98 (23.4%) had diabetes. Multivariable analyses showed that comorbidity of diabetes was an independent predictor of unfavorable outcome at 24 h (OR=0.534, 95% CI 0.316 to 0.903, p=0.019), at day 7 (OR=0.382, 95% CI 0.220 to 0.665, p=0.001), and at 3 months (OR=0.464, 95% CI 0.266 to 0.808, p=0.007). In patients with LVO, diabetes was an independent predictor of incomplete recanalization 24 h after IVT (OR=0.268, 95% CI 0.075 to 0.955, p=0.042).ConclusionsDiabetic patients with AIS had unfavorable neurological outcome, potentially linked to incomplete recanalization after IVT.
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