Medial Occipital Lobe Hyperperfusion Identified by Arterial Spin-Labeling: A Poor Prognostic Sign in Patients with Hypoxic-Ischemic Encephalopathy

Abstract

SUMMARY: Hypoxic-ischemic encephalopathy carries an uncertain prognosis. We sought to retrospectively assess the prognostic value of arterial spin-labeling MR imaging in 22 adult patients diagnosed with hypoxic-ischemic encephalopathy. Quantitative CBF maps were generated from the M0 map, and arterial spin-labeling data on a per-voxel basis were regionally interrogated via visual inspection and ROI placement. Hyperperfusion was defined as regional increases in CBF of Ͼ20% (relative to global CBF) and/or Ͼ100 mL/100 g/min. Eleven of 22 patients had prominent bilateral medial occipital lobe hyperperfusion, all of whom died before hospital discharge. One patient who had nondistinct arterial spin-labeling hyperperfusion and restricted diffusion survived. Medial occipital lobe hyperperfusion is a distinctive pattern that merits prospective investigation in a cohort of patients with moderate hypoxic-ischemic encephalopathy to determine its predictive ability in patients with a higher likelihood of survival. ABBREVIATIONS:ASL ϭ arterial spin-labeling; HIE ϭ hypoxic-ischemic encephalopathy; MOLH ϭ medial occipital lobe hyperperfusion

Low b-value diffusion weighted imaging is promising in the diagnosis of brain death and hypoxic-ischemic injury secondary to cardiopulmonary arrest

“…Findings suggest that HIE patients have increased perfusion compared with normal controls, in direct contrast to the global hypoperfusion findings in BD. This is in agreement with prior studies demonstrating hyperperfusion with HIE using both ASL and contrast-based perfusion, reflecting the pathophysiologic course of whole-brain insults where initially there is overcompensation of flow to injured areas [ 38 – 43 ].…”

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

“…We speculated that perfusion abnormalities demonstrated on the ASL maps in the acute phase in our series may be explained by the presence of reduced blood supply in the setting of nonocclusive hypoxic-ischaemic encephalopathy. 24,[29][30][31] Finally, we acknowledge the several limitations of this study, most notably related to the retrospective study design and to the small number of patients included. However, the latter reflects the rarity of CLN in clinical practice, especially in the acute phase in the postoperative setting.…”

“…We speculated that perfusion abnormalities demonstrated on the ASL maps in the acute phase in our series may be explained by the presence of reduced blood supply in the setting of non-occlusive hypoxic–ischaemic encephalopathy. 24,29–31…”

Evaluation of 3‐dimensional stereotactic surface projection rendering of arterial spin labeling data in a clinical cohort

“…Multiple studies have demonstrated that ASL offers important insight into the hemodynamics underlying a variety of cerebrovascular pathologies 4,5,8,10,12–15,18,29–31 . These insights prove valuable to clinical decision‐making, 10,12–15,30,32 allowing clinicians to better risk‐stratify patients based on their likelihood of having an adverse cerebrovascular event as well as to better plan surgical or endovascular intervention.…”

“…Arterial spin labeling (ASL) is an MRI technique that allows for the noninvasive visualization and quantification of cerebral blood flow (CBF) 1,2 . It provides valuable information regarding cerebral perfusion in both normal physiological states and in the context of underlying cerebrovascular disease, including acute ischemic stroke, brain tumors, infection, demyelinating disease, dementia, moyamoya disease, and intracranial vascular malformations 2–14 . When ASL is incorporated into serial MRI examinations, it can provide valuable clinical insights into the hemodynamic progression of cerebrovascular disease as well as the hemodynamic response of these diseases to therapeutic interventions 2 …”