Tanja Schneider1, Tobias Mahraun2, Julian Schroeder3, Andreas Frölich2, Philip Hoelter4, Marlies Wagner5, Jean Darcourt6, Christophe Cognard6, Alain Bonafé7, Jens Fiehler2, Susanne Siemonsen2, Jan-Hendrik Buhk2. 1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany. tan.schneider@uke.de. 2. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany. 3. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany. 5. Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany. 6. Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France. 7. Départment de Neuroradiologie, Hospitalier Universitaire Gui de Chauliac, Montpellier, France.
Abstract
PURPOSE: The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS: This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS: Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION: The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
PURPOSE: The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in strokepatients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS: This retrospective multicenter study included 27 acute strokepatients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS: Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION: The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
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