Acute Ischemic Infarction Defined by a Region of Multiple Hypointense Vessels on Gradient-Echo T2* MR Imaging at 3T

Kaya, Dilaver; Di̇nçer, Alp; Yıldız, Mehmet Erdem; Çizmeli, Muzaffer; Erzen, Canan

doi:10.3174/ajnr.a1537

Cited by 26 publications

(27 citation statements)

References 28 publications

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“…Several reports and reviews of the clinical applications of SWI have suggested that it may be able to show increased oxygen extraction in regions of infarction or tissue hypoxemia [6,13,14,15,16]. Recently, several studies reported the presence of hypointense and enlarged vessels (CVS) in GRE sequences within acute ischemic territories due to major artery occlusion, and this was attributed to the BOLD effect secondary to elevated deoxyhemoglobin [1,2,3,4,8,9]. However, there are no reports in the literature evaluating SWI findings in the revascularization of hyperacute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, it was detected for 17 h or even up to 48 h after the onset of stroke [17,21]. For SWIs, the volume of the prominent CVSs was found to be larger than the DWI lesion volume, which for the most part gradually disappeared within 48 h after symptom onset in the natural course [9]. However, in forced reperfusion by thrombolysis, such as in our study, the prominent CVSs may be changed more abruptly than in the natural course.…”

Section: Discussionmentioning

confidence: 99%

“…The prominence is thought to be due to increased deoxyhemoglobin in the veins. This may be secondary to increased oxygen extraction fraction (OEF) due to reduced blood flow [1,2,5,7,8,9]. …”

Section: Introductionmentioning

confidence: 99%

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Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke

Baik

Choi

et al. 2012

Cerebrovasc Dis

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Background: The cortical vessel signs (CVSs) on susceptibility-weighted images (SWIs) have been reported in patients with hyperacute ischemic stroke. We evaluated the change of this susceptibility sign on the immediate SWI after full recanalization and its clinical implications. Methods: Nineteen hyperacute ischemic stroke patients who had acute large artery occlusion and underwent post-recanalization SWI were enrolled in this study. The patients had ICA (internal carotid artery, 2 cases), M1 (M1 segment of middle cerebral artery, 7 cases), M2 (M2 segment of middle cerebral artery, 1 cases), T (intracranial ICA bifurcation, 2 cases), ICA/M1 (4 cases) and basilar artery (3 cases) occlusion on imaging studies before thrombolysis and they underwent immediate magnetic resonance imaging, including the SWI, after full recanalization. The recanalization status was evaluated using the thrombolysis in cerebral infarction (TICI) scorebefore and after thrombolysis. The SWI images were evaluated for the presence of asymmetry of veins over the ischemic territory and this was correlated with the site of stenosis or occlusion. The veins in the ischemic territory were classified as ‘prominent’ if there were more numerous veins and/or large veins with a greater signal loss observed compared with the opposite normal hemisphere, ‘equal’ if there were no significant difference in appearance in both the cerebral hemispheres, and ‘less’ if the veins were decreased in the affected area as compared with that of the normal cortex. Baseline clinical parameters and clinical outcomes were reviewed. Results: The initial TICI grades were 0 in all cases. After thrombolysis, TICI grades were 3 in all cases. The pre-recanalization SWIs were obtained in 10 of 19 patients and all 10 showed prominent CVSs over the affected side, which disappeared on the post-recanalization SWI. On the post-recanalization SWI, the observed veins in the affected area were equal (10/19), less (5/19), and both equal and less (4/19). Patients with equal cortical veins in the affected area had small lesions on diffusion-weighted image (DWI) (10/19), while patients with less cortical veins had medium to large lesions on DWI (9/19). Conclusion: The prominent CVSson SWI can be indicative of acute thromboembolic occlusion and its change immediately after recanalization can be used to reflect the metabolic status. After recanalization, the appearance of the equal CVS (return to normal) on SWI was associated with a favorable clinical outcome and infarction was avoided in our small series study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke

Baik

Choi

et al. 2012

Cerebrovasc Dis

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“…Marked hypointense vessels on gradient-recalled echo or SWI sequences are considered to reflect veins with increased deoxyhemoglobin concentration that drain the ischemic territory with increased oxygen extraction fraction. The extent of cerebral tissue with marked hypointense vessels has been shown to harbor a close correlation with the area of perfusion deficit (24,25) and hence can be used as a marker of hemodynamic compromise within the territory of arterial occlusion. Few studies in literature have analyzed the relationship between outcome and the presence of marked hypointense vessels on SWI, with discrepant results.…”

Section: Discussionmentioning

confidence: 99%

Bright and dark vessels on stroke imaging: different sides of the same coin?

Vural

Göçmen²,

Oğuz³

et al. 2016

Diagn Interv Radiol

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T he determination of the extent of brain tissue that is ischemic, but still viable and therefore under risk for irreversible injury (i.e., penumbra), is one of the major goals in acute stroke imaging (1). Advances in technology and the availability of perfusion imaging, either by computed tomography (CT) or magnetic resonance imaging (MRI), are major steps in this regard, and multi-modal imaging by CT or MRI is gaining importance as a tool in the development of both prognostic and therapeutic algorithms in acute stroke (2). Despite these developments, there are certain roadblocks in the utilization of perfusion imaging, with MRI in particular, in acute stroke patients. These include the unavailability of resources, primarily MRI scanners, in emergency departments; the need for technical and medical personnel for the postprocessing and interpretation of perfusion images, which can partially be overcome by automated imaging softwares; and the use of intravenous contrast agents, which are highly critical in patients with renal failure.Disregarding perfusion imaging by arterial spin labeling, other imaging signatures of compromised tissue perfusion that can be detected by MRI sequences that do not necessitate the use of contrast administration might provide clinicians with alternative and more practical tools in this setting. One of these signatures is the hyperintense vessel sign (HVS) observed on fluid-attenuated inversion recovery (FLAIR) imaging, which is considered to reflect slow and compensatory blood flow within leptomeningeal collaterals distal to the proximal occlusion (3). Prior studies have shown that patients with HVS evident on FLAIR are more like- PURPOSEProminent hypointense cerebral vessels on susceptibility-weighted imaging (SWI) and the hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) imaging are considered as markers of compromised tissue perfusion in cerebral ischemia. In this study, we aimed to identify the correlation between HVS on FLAIR and hypointense vessels on SWI, and to determine whether these imaging features provide independent prognostic information in patients with ischemic stroke. METHODSWe retrospectively analyzed consecutive ischemic stroke patients with proximal middle cerebral artery (MCA) occlusion who underwent SWI and FLAIR within 24 h of symptom onset. The presence of hypointense vessels on SWI and hyperintense vessels on FLAIR in >4 of 10 slices encompassing the MCA territory were considered to represent prominent hypoperfusion. RESULTSAmong 50 patients, 62% had a prominent HVS on FLAIR and 68% had prominent hypointense vessels on SWI. There was a moderate but significant correlation between the number of slices with HVS on FLAIR and prominent hypointense vessels on SWI (r=0.425, P = 0.002). In multivariate analyses, the prominence of hypointense vessels on SWI, but not HVS on FLAIR, was significantly associated with a higher discharge NIHSS score (P = 0.027), mRS score (P = 0.021), and lesion growth (P = 0.050). CONCLUSIONThe significant, al...

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“…It has been reported that SWI and computed tomography have similar sensitivity in diagnosing cerebral hemorrhage (13). It was later shown that SWI can be used in the diagnosis of cerebrovascular diseases (to determine the location of an arterial thrombus and ischemic penumbra in acute ischemic stroke), CVT, hemorrhagic cerebral diseases, vascular malformations, tumors, neurodegenerative disorders, trauma, vasculitis, epilepsy, and multiple sclerosis (6,7,9,14). SWI sequencing shows the normal anatomy of cerebral veins, their variations, and anomalies.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Findings in Cerebral Venous Thrombosis due to Behcet's Disease and the Importance of Susceptibility-Weighted Imaging: Case Report

Bulut¹,

Yavuz²,

Milanlıoğlu³

et al. 2015

Türk Beyin Damar Hast Derg

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Acute Ischemic Infarction Defined by a Region of Multiple Hypointense Vessels on Gradient-Echo T2* MR Imaging at 3T

Cited by 26 publications

References 28 publications

Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke

Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke

Bright and dark vessels on stroke imaging: different sides of the same coin?

Magnetic Resonance Imaging Findings in Cerebral Venous Thrombosis due to Behcet's Disease and the Importance of Susceptibility-Weighted Imaging: Case Report

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