Björk-Shiley Convexoconcave Valves: Susceptibility Artifacts at Brain MR Imaging and Mechanical Valve Fractures

Gorp, M.J. van; Graaf, Yolanda van der; Mol, Bas A.J.M. de; Bakker, Chris J.G.; Witkamp, Theo D.; Ramos, L. M. P.; Mali, Willem P.Th.M.

doi:10.1148/radiol.2303021619

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…23 The differential diagnosis of CMBs, however, also includes microcalcifications 10 and even the release of prosthetic heart valve material, 24 both of which certainly do not increase the risk for SICH. The spatial distribution of CMBs is very similar to the usual sites of ICH, and the existence of higher numbers of CMBs represents an independent factor for the overall incidence of ICH.…”

Section: Discussionmentioning

confidence: 99%

B leeding R isk A nalysis in S troke I maging Before Thrombo L ysis (BRASIL)

Fiehler

Albers

Boulanger

et al. 2007

Stroke

227

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Background and Purpose-There has been speculation that the risk of secondary symptomatic intracranial hemorrhage (SICH) may be increased after thrombolytic therapy in ischemic stroke patients who have cerebral microbleeds (CMBs) on T2*-weighted magnetic resonance imaging. Because of this concern, some centers withhold potentially beneficial thrombolytic therapy from these patients. Methods-We analyzed magnetic resonance imaging data acquired within 6 hours after symptom onset from 570 ischemic stroke patients treated with intravenous tissue plasminogen activator in 13 centers in Europe, North America, and Asia. Baseline T2*-weighted magnetic resonance images were evaluated for the presence of CMBs. The primary end point was SICH, defined as clinical deterioration with an increase in the National Institutes of Health Stroke Scale score by Ն4 points, temporally related to a parenchymal hematoma on follow-up-imaging. Results-A total of 242 CMBs were detected in 86 of 570 patients (15.1%). The number of CMBs ranged from 1 to 77 in the individual patient, with Ն5 CMBs in 6 of 570 patients (1.1%). Proportions of patients with SICH were 5.8% (95% CI, 1.9 to 13.0) in the presence of CMBs and 2.7% (95% CI, 1.4 to 4.5) in patients without CMBs (Pϭ0.170, Fisher's exact test), resulting in no significant absolute increase in the risk of SICH of 3.1% (95% CI, Ϫ2.0 to 8.3). Conclusions-The data suggest that if there is any increased risk of SICH attributable to CMBs, it is likely to be small and unlikely to exceed the benefits of thrombolytic therapy. No reliable conclusion regarding risk in the rare patient with multiple CMBs can be reached.

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Section: Discussionmentioning

confidence: 99%

B leeding R isk A nalysis in S troke I maging Before Thrombo L ysis (BRASIL)

Fiehler

Albers

Boulanger

et al. 2007

Stroke

227

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“…Follow-up MRI examinations were available for 56 patients with a median time after first postinterventional scan of 6 months (interquartile range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In 91.1% (51/56) of those, there was no further increase in SWI lesions (Figure 2).…”

Section: Further Follow-up Mri Scansmentioning

confidence: 99%

“…[4][5][6][7][8] In patients with mechanical heart valves (mHV), SWI lesions have been described that were originally suspected to be caused by small metallic emboli by degenerative metallic abrasion of the valve structure. [9][10][11] Although older mHV had a metallic shackle, modern mHV consist of pyrolytic carbon except the noble metal stent structure in some models or the annulus, which may be made up of titanium covered by a Dacron textile. This change of composition calls into question the metallic abrasion hypothesis.…”

mentioning

confidence: 99%

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Breiding

Duerrenmatt

Meinel

et al. 2019

JAHA

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BackgroundIn patients with mechanical heart valves, cerebral susceptibility‐weighted imaging (SWI) lesions on magnetic resonance imaging, postulated to be caused by degenerative metallic abrasion, are frequently referred to as valve abrasion. It remains unclear whether valve implantation not requiring cardiopulmonary bypass or biological heart valves also shows those lesions.Methods and ResultsTwo blinded readers rated SWI lesions and cerebral amyloid angiopathy probability according to established criteria on brain magnetic resonance imaging pre‐ and postinterventionally. We assessed the association between valve type/cardiopulmonary bypass use and SWI lesion count on the first postinterventional scan using multivariable logistic regression. On postinterventional magnetic resonance imaging, 57/58 (98%) patients with mechanical heart valves had at least 1 and 46/58 (79%) 3 or more SWI lesions, while 92/97 (95%) patients with biological heart valves had at least 1 and 72/97 (74%) 3 or more SWI lesions. On multivariate analysis, duration of cardiopulmonary bypass during implantation significantly increased the odds of having SWI lesions on the first postinterventional magnetic resonance imaging (β per 10 minutes 0.498; 95% CI, 0.116–0.880; P=0.011), whereas valve type showed no significant association (P=0.338). Thirty‐seven of 155 (23.9%) patients fulfilled the criteria of possible/probable cerebral amyloid angiopathy.Conclusions SWI lesions in patients with artificial heart valves evolve around the time point of valve implantation and the majority of patients had multiple lesions. The missing association with the valve type weakens the hypothesis of degenerative metallic abrasion and highlights cardiopulmonary bypass as the main risk factor for SWI occurrence. SWI lesions associated with cardiac procedures can mimic cerebral amyloid angiopathy. Further research needs to clarify whether those lesions are associated with intracranial hemorrhage after intravenous thrombolysis or anticoagulation.

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“…It is also obvious that not only old hemoglobin degradation products can cause susceptibility artefacts. Mimics of hemorrhages include iron without hemorrhage, calcification, air, microcavernomas and even the release of prosthetic heart valve materials [44].…”

Section: What Are Cerebral Microbleeds?mentioning

confidence: 99%

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

Fiehler

Kucinski

2006

Clin Neuroradiol

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It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke patients. However, the term "intracerebral hemorrhage" (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear to be a general marker of various types of bleeding-prone small vessel disease and a predictor of recurrent vascular events. Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not be ruled out.

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Björk-Shiley Convexoconcave Valves: Susceptibility Artifacts at Brain MR Imaging and Mechanical Valve Fractures

Abstract: Susceptibility artifacts at brain MR imaging are not restricted to patients with BSCC valves. These artifacts can be seen on images obtained in patients with various other types of fractured and intact prosthetic heart valves.

Cited by 10 publications

References 21 publications

B leeding R isk A nalysis in S troke I maging Before Thrombo L ysis (BRASIL)

B leeding R isk A nalysis in S troke I maging Before Thrombo L ysis (BRASIL)

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

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