Bastian Cheng1, Nikolaus Schröder1, Nils Daniel Forkert2, Peter Ludewig1, André Kemmling3, Tim Magnus1, Jens Fiehler4, Christian Gerloff1, Götz Thomalla1. 1. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N4N1, Canada. 3. Department of Neuroradiology, University Clinic Schleswig-Holstein, Lübeck, Germany. 4. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND AND PURPOSE: The diagnostic value of susceptibility-weighted magnetic resonance imaging of acute stroke patients has shown potential as a surrogate marker of impaired hemodynamics. We investigate the value of asymmetrical hypointense cerebral vessels (HV) for the identification of vessel status and tissue at risk of infarction (TaR). METHODS: Symmetry of HV was visually rated on SWI data from a well-defined population of acute anterior circulation stroke with onset <24 hours. MRI perfusion data was analyzed and volumes of tissue at risk segmented using a delay threshold of Tmax> 6 seconds. Status of the extra- and intracranial arteries was assessed by ultrasound and MR angiography. RESULTS: 35 patients were included (12 women; median age 69 years, IQR 61-77; median NIHSS at admission 10, IQR 6-20). Asymmetrically distributed HV were detected at the stroke hemisphere in 25 patients (71%). Of those, 12 patients displayed occlusion of the middle cerebral artery, whereas occlusion of the extracranial ICA was detected in 6 patients. TaR was larger, yet not significantly different in patients with asymmetrically HV (mean volume 38.9 ml, SD 52.9 ml) compared to patients showing symmetrical HV (4.2 ml; SD 10.7 ml, p-value 0.081). Significant differences where, however, found after excluding patients with extracranial ICA occlusions (42.9 ml; SD 50.4 ml vs. 4.2 ml, SD 10.8 ml, p-value 0.025). CONCLUSION: Visual analysis of HV in SWI identifies tissue at risk in patients with anterior circulation stroke. Potentially pre-existing extracranial ICA occlusions leading to prominent HV have to be considered as a confounding factor.
BACKGROUND AND PURPOSE: The diagnostic value of susceptibility-weighted magnetic resonance imaging of acute strokepatients has shown potential as a surrogate marker of impaired hemodynamics. We investigate the value of asymmetrical hypointense cerebral vessels (HV) for the identification of vessel status and tissue at risk of infarction (TaR). METHODS: Symmetry of HV was visually rated on SWI data from a well-defined population of acute anterior circulation stroke with onset <24 hours. MRI perfusion data was analyzed and volumes of tissue at risk segmented using a delay threshold of Tmax> 6 seconds. Status of the extra- and intracranial arteries was assessed by ultrasound and MR angiography. RESULTS: 35 patients were included (12 women; median age 69 years, IQR 61-77; median NIHSS at admission 10, IQR 6-20). Asymmetrically distributed HV were detected at the stroke hemisphere in 25 patients (71%). Of those, 12 patients displayed occlusion of the middle cerebral artery, whereas occlusion of the extracranial ICA was detected in 6 patients. TaR was larger, yet not significantly different in patients with asymmetrically HV (mean volume 38.9 ml, SD 52.9 ml) compared to patients showing symmetrical HV (4.2 ml; SD 10.7 ml, p-value 0.081). Significant differences where, however, found after excluding patients with extracranial ICA occlusions (42.9 ml; SD 50.4 ml vs. 4.2 ml, SD 10.8 ml, p-value 0.025). CONCLUSION: Visual analysis of HV in SWI identifies tissue at risk in patients with anterior circulation stroke. Potentially pre-existing extracranial ICA occlusions leading to prominent HV have to be considered as a confounding factor.