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Leptomeningeal collateralization in acute ischemic stroke: impact on prominent cortical veins in susceptibility-weighted imaging.
- Source :
-
European journal of radiology [Eur J Radiol] 2014 Aug; Vol. 83 (8), pp. 1448-54. Date of Electronic Publication: 2014 May 17. - Publication Year :
- 2014
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Abstract
- Background: The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings.<br />Methods: 33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented.<br />Results: 20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p=0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p<0.00).<br />Conclusions: In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill-perfused areas than SWI, especially in good collateralized subjects.<br /> (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Aged
Angiography, Digital Subtraction
Brain Ischemia diagnostic imaging
Cerebral Veins diagnostic imaging
Female
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Stroke diagnostic imaging
Brain Ischemia pathology
Cerebral Veins pathology
Collateral Circulation
Diffusion Magnetic Resonance Imaging methods
Magnetic Resonance Angiography methods
Meninges blood supply
Stroke pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7727
- Volume :
- 83
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- European journal of radiology
- Publication Type :
- Academic Journal
- Accession number :
- 24882785
- Full Text :
- https://doi.org/10.1016/j.ejrad.2014.05.001