Sven Dekeyzer1,2, Arno Reich3, Ahmed E Othman4, Martin Wiesmann5, Omid Nikoubashman5. 1. Department of Medical Imaging, Onze-Lieve-Vrouw (OLV) Ziekenhuis Aalst, Moorselbaan 164, 9300, Aalst, Belgium. Sven.Dekeyzer@gmail.com. 2. Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. Sven.Dekeyzer@gmail.com. 3. Department of Neurology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. 4. Department of Radiology, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany. 5. Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Abstract
PURPOSE: A pseudo-normalization of infarcted brain parenchyma, similar to the "fogging effect" which usually occurs after 2-3 weeks, can be observed on CT performed immediately after endovascular stroke treatment (EST). Goal of this study was to analyze the incidence of this phenomenon and its evolution on follow-up imaging. METHODS: One hundred fifty-two patients in our database of 949 patients, who were treated for acute stroke between January 2010 and January 2015, fulfilled the inclusion criteria of (a) EST for an acute stroke in the anterior circulation, (b) an ASPECT-score < 10 on pre-interventional CT, and (c) postinterventional CT imaging within 4.5 h after the procedure. Two independent reviewers analyzed imaging data of these patients. RESULTS: Transformation of brain areas from hypoattenuated on pre-interventional CT to isodense on postinterventional CT was seen in 37 patients in a total of 49 ASPECTS areas (Cohen's kappa 0.819; p < 0.001). In 17 patients, the previously hypoattenuated brain areas became isodense, but appeared swollen. In 20 patients (13%), the previously hypodense brain area could not be distinguished from normal brain parenchyma. On follow-up imaging, all isodense brain areas showed signs of infarction. CONCLUSION: Pseudo-normalization of infarct hypoattenuation on postinterventional CT is not infrequent. It is most likely caused by contrast leakage in infarcted parenchyma and does not represent salvage of ischemic brain parenchyma.
PURPOSE: A pseudo-normalization of infarcted brain parenchyma, similar to the "fogging effect" which usually occurs after 2-3 weeks, can be observed on CT performed immediately after endovascular stroke treatment (EST). Goal of this study was to analyze the incidence of this phenomenon and its evolution on follow-up imaging. METHODS: One hundred fifty-two patients in our database of 949 patients, who were treated for acute stroke between January 2010 and January 2015, fulfilled the inclusion criteria of (a) EST for an acute stroke in the anterior circulation, (b) an ASPECT-score < 10 on pre-interventional CT, and (c) postinterventional CT imaging within 4.5 h after the procedure. Two independent reviewers analyzed imaging data of these patients. RESULTS: Transformation of brain areas from hypoattenuated on pre-interventional CT to isodense on postinterventional CT was seen in 37 patients in a total of 49 ASPECTS areas (Cohen's kappa 0.819; p < 0.001). In 17 patients, the previously hypoattenuated brain areas became isodense, but appeared swollen. In 20 patients (13%), the previously hypodense brain area could not be distinguished from normal brain parenchyma. On follow-up imaging, all isodense brain areas showed signs of infarction. CONCLUSION: Pseudo-normalization of infarct hypoattenuation on postinterventional CT is not infrequent. It is most likely caused by contrast leakage in infarcted parenchyma and does not represent salvage of ischemic brain parenchyma.
Authors: G Parrilla; B García-Villalba; M Espinosa de Rueda; J Zamarro; E Carrión; F Hernández-Fernández; J Martín; R Hernández-Clares; A Morales; A Moreno Journal: AJNR Am J Neuroradiol Date: 2012-04-26 Impact factor: 3.825
Authors: J H Pexman; P A Barber; M D Hill; R J Sevick; A M Demchuk; M E Hudon; W Y Hu; A M Buchan Journal: AJNR Am J Neuroradiol Date: 2001-09 Impact factor: 3.825
Authors: N Lummel; G Schulte-Altedorneburg; C Bernau; T Pfefferkorn; M Patzig; H Janssen; C Opherk; H Brückmann; J Linn Journal: AJNR Am J Neuroradiol Date: 2013-08-01 Impact factor: 3.825
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245