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Yaghi S, Grory BM, Prabhakaran S, Yeatts SD, Cutting S, Jayaraman M, Sacchetti D, Furie K, Zaidat OO, Liebeskind DS, Khatri P. Infarct Pattern, Perfusion Mismatch Thresholds, and Recurrent Cerebrovascular Events in Symptomatic Intracranial Stenosis. J Neuroimaging 2019; 29:640-644. [PMID: 31112323 DOI: 10.1111/jon.12630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Studies have shown an association between infarct patterns and recurrent stroke in patients with symptomatic intracranial stenosis (sICAS) but there are limited data on associations with perfusion imaging mismatch profile. We aim to determine the association between infarct pattern, optimal mismatch profile definition, and recurrent cerebrovascular events (RCVE) in patients with anterior circulation sICAS. METHODS This is a retrospective study of consecutive patients with acutely sICAS admitted to a comprehensive stroke center over 18 month's period. Patients with sICAS underwent magnetic resonance perfusion (MRP) imaging within 24 hours from admission. Infarct patterns (internal BZ [IBZ], cortical BZ [CBZ], and core/perforator [C/P]) and RCVE within 90 days, were independently adjudicated by two reviewers. We compared mismatch profiles and recurrent event rates across infarct patterns. RESULTS Twenty-five patients met inclusion criteria; 28% had IBZ infarcts and overall RCVE rate was 32.0%. When compared to patients without IBZ infarcts, those with IBZ infarcts were more likely to have a target mismatch profile using Tmax > 6 seconds (60% vs. 6.7%, P = .007) and RCVE (62.5% vs. 11.8%, P = .01). There were no associations between CBZ and C/P infarcts and target mismatch profiles and RCVE. CONCLUSION IBZ infarcts may be a surrogate marker of distal perfusion status and RCVE risk. Larger multicenter, prospective, core-lab blindly adjudicated studies are needed to confirm our findings.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, New York Langone Medical Center, New York, NY.,Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Brian Mac Grory
- Department of Neurology, New York Langone Medical Center, New York, NY
| | - Shyam Prabhakaran
- Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Sharon D Yeatts
- Department of Neurology, Northwestern University, Chicago, IL
| | - Shawna Cutting
- Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Mahesh Jayaraman
- Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.,Department of Diagnostic Imaging, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Daniel Sacchetti
- Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Karen Furie
- Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Osama O Zaidat
- Department of Neurosurgery, the Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Pooja Khatri
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA.,Department of Neurology, University of Cincinnati, Cincinnati, OH
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Liang J, Liu Y, Xu X, Shi C, Luo L. Cerebral Perforating Artery Disease : Characteristics on High-Resolution Magnetic Resonance Imaging. Clin Neuroradiol 2018; 29:533-541. [PMID: 29572675 DOI: 10.1007/s00062-018-0682-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Our aims were to evaluate the feasibility of high-resolution magnetic resonance imaging (HR-MRI) for displaying the cerebral perforating arteries in normal subjects and to discuss the value of HR-MRI for detecting the causes of infarctions in the territory of the lenticulostriate artery (LSA). METHODS Included in this study were 31 healthy subjects and 28 patients who had infarctions in the territory supplied by the LSA. The T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and HR-MRI, including 3‑dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3D fast spin-echo T1WI (namely CUBE T1 in GE Healthcare), were applied on a 3-Tesla scanner. The numbers and route of the perforating arteries on both sides were independently confirmed on HR-MRI by two physicians. The Wilcoxon test was used to compare the differences. RESULTS The numbers of perforating arteries in healthy subjects observed on 3D-TOF-MRA were as follows: numbers of the bilateral recurrent artery of Heubner (RAH) ranged from 0-3 (median 1), numbers of the left LSA ranged from 0-7 (median 3), numbers of the right LSA ranged from 0-5 (median 3), numbers of the bilateral anterior choroidal artery ranged from 1-2 (median 1) and the numbers of the bilateral thalamoperforating artery ranged from 1-2 (median 1). In the patients with lenticulostriate infarctions, the numbers of LSAs on the affected side were lower than on the opposite and ipsilateral sides in the healthy subjects. The results were statistically significant. An abnormality of the RAH may lead to a centrum semiovale infarct pattern, whereas an abnormality of the LSA is associated with a corona radiata infarct pattern. CONCLUSION The use of HR 3D-TOF-MRA and CUBE T1 had unique advantages in displaying the tiny perforating arteries in vivo. Moreover, effective recognition of the associated cerebral perforating artery and infarct patterns may enhance our understanding of the mechanism of stroke in patients with lenticulostriate infarctions.
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Affiliation(s)
- Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yiyong Liu
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiaoshuang Xu
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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