CT Sign of Brain Swelling without Concomitant Parenchymal Hypoattenuation: Comparison with Diffusion- and Perfusion-weighted MR Imaging

Na, Dong Gyu; Kim, Eung Yeop; Ryoo, Jae Wook; Lee, Kwang Ho; Roh, Hong Gee; Kim, Sam Soo; Song, In Chan; Chang, Kee-Hyun

doi:10.1148/radiol.2353040571

Cited by 73 publications

(59 citation statements)

References 27 publications

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“…19,20 However, other studies demonstrated that SE does not necessarily mean severe ischemic injury, especially if parenchymal hypoattenuation is absent. 1,21,22 An important limitation of noncontrast CT studies with respect to SE is poor agreement in distinguishing and estimating SE, even among experienced clinicians. 5,6,22 By contrast, the intraobserver and interobserver agreements were excellent in this study.…”

Section: Se On Flair Mrimentioning

confidence: 99%

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Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke

Kim

Ryoo

et al. 2012

Stroke

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Background and Purpose-The clinical significance of sulcal effacement has been widely investigated in CT studies, but the results are controversial. In this study, we evaluated the presence of perisylvian sulcal effacement (PSE) on fluid attenuation inversion recovery MRI and hypothesized that PSE may be related to collateral flow status together with hyperintense vessels on fluid attenuation inversion recovery in hyperacute stroke. In addition, we investigated whether an association between PSE and clinical outcome could be found in these patients. Methods-Consecutive patients with acute middle cerebral artery infarcts within 6 hours of symptom onset were included.All patients had internal carotid artery or middle cerebral artery occlusion and underwent MRI including FLAIR. The presence of PSE and hyperintense vessels on fluid attenuation inversion recovery and the collateral status and occurrence of early recanalization (ER) on conventional angiography were evaluated. Results-Of 139 patients, 79 (56.8%) had PSE. Multivariate testing revealed PSE was independently associated with collateral status. The association between hyperintense vessels and collaterals was different depending on PSE.Compared to PSE-positive and ER-negative patients, PSE-negative and ER-negative patients (odds ratio, 4.11; 95% confidence interval, 1.12-15.17) and PSE-negative and ER-positive patients (odds ratio, 34.62; 95% confidence interval, 5.75-208.60), but not PSE-positive and ER-positive patients, were more likely to experience favorable clinical outcomes (modified Rankin Scale score Յ2 at 3 months). Conclusions-PSE is independently associated with collateral status in patients with acute middle cerebral artery stroke. Moreover, PSE in conjunction with recanalization status can predict clinical outcomes in these patients. (Stroke. 2012;43:386-392.)

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Section: Se On Flair Mrimentioning

confidence: 99%

“…1 The EIC correlate with baseline stroke severity. 2 In addition, there is a trend of reduced risk and increased benefit to thrombolysis if the EIC on baseline CT are not extensive.…”

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confidence: 99%

Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke

Kim

Ryoo

et al. 2012

Stroke

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“…29,30 Whereas loss of gray-white differentiation is consistent with infarction, 31 cerebral swelling may be intermixed, extending the apparent boundary of infarct. Cerebral swelling is associated with a variable and lower stroke risk 32 and may account for overestimation of initial infarct size on NCCT. Use of ASPECTS on CTA signal intensity allows easier detection of the infarct extent and provides additional information.…”

Section: Discussionmentioning

confidence: 99%

Alberta Stroke Program Early CT Scoring of CT Perfusion in Early Stroke Visualization and Assessment

Aviv¹,

Mandelcorn²,

Chakraborty³

et al. 2007

American Journal of Neuroradiology

154

115

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BACKGROUND AND PURPOSE:Qualitative CT perfusion (CTP) assessment by using the Alberta Stroke Program Early CT Score (ASPECTS) allows rapid calculation of infarct extent for middle cerebral artery infarcts. Published thresholds exist for noncontrast CT (NCCT) ASPECTS, which may distinguish outcome/complication risk, but early ischemic signs are difficult to detect. We hypothesized that different ASPECTS thresholds exist for CTP parameters versus NCCT and that these may be superior at predicting clinical and radiologic outcome in the acute setting.

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“…Most patients were managed conservatively (only 2 IAT), and only 35% to 50% had lack of infarct within the ISE territory on follow-up imaging. 4,5 The frequency of ISE in our report compares favorably (7.4%), despite including only patients with confirmed large vessel occlusion. The CT perfusion patterns of our patients are comparable.…”

Section: Discussionmentioning

confidence: 43%

“…2,3 Sulcal effacement on NCCT and concomitant preservation of the underlying gray-white matter junction (isolated sulcal effacement [ISE]) may not represent cytotoxic edema. 1,4,5 We aimed to evaluate the frequency and significance of ISE in patients with large vessel occlusion acute ischemic stroke (AIS) undergoing intra-arterial therapy (IAT).…”

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confidence: 99%

Sulcal Effacement With Preserved Gray–White Junction

Haussen

Lima

Frankel

et al. 2015

Stroke

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Background and Purpose— Sulcal effacement with preserved underlying gray–white matter junction (isolated sulcal effacement [ISE]) in acute ischemic stroke may not represent irreversible parenchymal injury. We aimed to evaluate the frequency and significance of ISE in patients with large vessel occlusion acute ischemic stroke. Methods— Consecutive acute ischemic stroke patients with middle cerebral artery M1 or internal carotid artery terminus occlusions who underwent computed tomography angiogram/perfusion followed by intra-arterial therapy were screened for ISE. Results— Out of the 568 patients who underwent intra-arterial therapy between March 2011 and September 2014, 108 fulfilled inclusion criteria. ISE was present in 8 (7.4%) patients (age 55.7±10.5 years, 6 female, baseline National Institutes of Health Stroke Scale 16.1±3.8, 5 middle cerebral artery-M1, and 3 internal carotid artery terminus occlusions). Computed tomography angiogram revealed engorged/dilated leptomeningeal vessels obliterating the sulci within the areas of effacement, whereas computed tomography perfusion indicated normal-to-increased cerebral blood volume and prolonged T max in all patients. Modified treatment in cerebral ischemia (mTICI) 2b-3 reperfusion was achieved in all patients. Follow-up imaging confirmed no infarct in the ISE area in all patients, and 5 (62%) had modified Rankin Scale 0 to 2 at 3 months. Conclusions— Sulcal effacement with preserved gray–white delineation is occasionally visualized in patients with proximal occlusion strokes, relates to robust leptomeningeal collaterals, and indicates preserved underlying parenchyma. ISE should not be used to exclude patients from thrombectomy.

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CT Sign of Brain Swelling without Concomitant Parenchymal Hypoattenuation: Comparison with Diffusion- and Perfusion-weighted MR Imaging

Abstract: The CT sign of brain swelling without concomitant parenchymal hypoattenuation in patients with acute cerebral ischemia does not represent severe ischemic damage and may suggest ischemic penumbral or oligemic tissue.

Cited by 73 publications

References 27 publications

Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke

Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke

Alberta Stroke Program Early CT Scoring of CT Perfusion in Early Stroke Visualization and Assessment

Sulcal Effacement With Preserved Gray–White Junction

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