Whole-Brain Arterial Spin Labeling Perfusion MRI in Patients With Acute Stroke

Bokkers, Reinoud P H; Hernandez, Daymara A.; Merino, José G.; Mirasol, Raymond V.; Osch, Matthias J.P. van; Hendrikse, Jeroen; Warach, Steven; Latour, Lawrence L.

doi:10.1161/strokeaha.110.589234

Cited by 100 publications

(108 citation statements)

References 27 publications

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“…В нескольких исследованиях продемонстрировали, что перфузионно-взвешенная магнитно-резонансная томография (ПВ-МРТ) на основе мечения артериальных спинов (ASL) позволяет обнаружить зоны гипоперфу-зии и перфузионно-диффузионное несоответствие при остром инсульте с умеренной или четкой корреляцией с данными перфузионной МРТ с контрастом [1][2][3][4].…”

Section: ключевые слова: ишемия (Ischemia) перфузионные изображения unclassified

“…[1][2][3][4] Recently, ASL-PWI has been incorporated as a part of the acute ischemic stroke evaluation in our institution, and with its increasing use, we have encountered patients with acute ischemic stroke in whom a characteristic bright intravascular signal (which we termed bright vessel appearance) is found within an occluded arterial segment. To our knowledge, the usefulness of ASL bright vessel appearance in patients with acute ischemic stroke has not been elucidated yet.…”

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confidence: 99%

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Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic Stroke

Yoo

Yun

Rhim

et al. 2015

Stroke

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564S everal studies have demonstrated that arterial spin labeling (ASL)-perfusion-weighted imaging (PWI) can detect hypoperfusion and perfusion-diffusion mismatch in the setting of acute stroke, with good to modest correlation to dynamic susceptibility contrast perfusion MRI. [1][2][3][4] Recently, ASL-PWI has been incorporated as a part of the acute ischemic stroke evaluation in our institution, and with its increasing use, we have encountered patients with acute ischemic stroke in whom a characteristic bright intravascular signal (which we termed bright vessel appearance) is found within an occluded arterial segment. To our knowledge, the usefulness of ASL bright vessel appearance in patients with acute ischemic stroke has not been elucidated yet. The purpose of our study was, therefore, to evaluate whether the bright vessel appearance on ASL-PWI can help localize sites of arterial occlusion in patients with acute ischemic stroke. MethodsThis retrospective study was approved by our institutional review board, and informed consent was waived. PatientsOur radiology database from January 2014 to April 2014 was searched for patients who underwent MRI for suspected acute ischemic stroke. Among 171 patients, those whose MR images showed infarctions, as identified by areas of restricted diffusion, were included. Fifty-four patients were excluded for the following reasons: (1) no ASL images, (2) ASL images of poor image quality because of inadequate acquisition times or artifacts, or (3) occlusions at the extracranial carotid arteries (in which arterial labeling was insufficient). As a result, 117 consecutive patients were included in this study. MRI ProtocolAll patients underwent MRI at a 1.5T (Signa HDxt; GE Medical Systems, Milwaukee, WI [n=70]) or 3.0T (Verio; Siemens, Erlangen, Germany [n=47]) MR scanner using a 16-channel head coil. Our MRI Background and Purpose-The purpose of this study was to evaluate whether bright vessel appearance on arterial spin labeling (ASL) MRI can help localize arterial occlusion sites in patients with acute ischemic stroke. Methods-Patients who underwent MRI for suspected acute ischemic stroke, as identified by an area of restricted diffusion, were included. All images were visually analyzed for the presence or absence of (1) arterial occlusion on time-of-flight MR angiography, (2) bright vessel appearance on ASL images, and (3) susceptibility vessel sign. McNemar 2-tailed test was used to compare the sensitivities of ASL and susceptibility-weighted imaging for the detection of arterial occlusion, using MR angiography as the reference standard. Results-ASL bright vessel appearance was significantly more common in the group with occlusion than in the group without occlusion (94% protocol for acute stroke evaluation included diffusion-weighted imaging, fluid-attenuated inversion recovery, susceptibility-weighted imaging (SWI), ASL-PWI, and 3-dimensional time-of-flight MR angiography. ASL-PWI scans were performed using a pseudocontinuous ASL pulse sequence. The signal intensity chan...

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Section: ключевые слова: ишемия (Ischemia) перфузионные изображения unclassified

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confidence: 99%

Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic Stroke

Yoo

Yun

Rhim

et al. 2015

Stroke

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“…This technique has been evaluated in healthy individuals in comparison with PET [13]. ASL-MRI has also been used to describe perfusion deficits in patients with cerebrovascular disease [14,15,16,17,18,19]. In a recent study of transient ischaemic attack patients, perfusion-related alterations on ASL were more frequently detected compared with DSC-MRI or intracranial MRA [20].…”

Section: Discussionmentioning

confidence: 99%

Continuous Magnetic Resonance Perfusion Imaging Acquisition during Systemic Thrombolysis in Acute Stroke

et al. 2013

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Background: Early recanalization and increase in collateral blood supply are powerful predictors of favourable outcome in acute ischaemic stroke. The factors contributing to the heterogeneous response to intravenous thrombolysis therapy in individual patients, however, are not fully understood. The on-going single-centre ‘MR perfusion imaging during thrombolysis' study uses repetitive arterial spin labelling (ASL) measurements to characterize the haemodynamic processes in acute stroke during therapy. The first milestone was to develop an appropriate infrastructure for thrombolysis in the magnetic resonance imaging (MRI) scanner without time delay and ensuring optimal patient safety and care. Methods: Between February and December 2011, 16 patients with acute neurological symptoms suggestive of hemispheric stroke within 4.5 h after symptom onset were included. In addition to clinical data, we documented the time from onset to arrival at the hospital, start and duration of MRI examination, start of thrombolytic therapy, and complications. The decision to thrombolyse was made after a routine stroke MRI protocol. During the 60-min systemic thrombolysis, repetitive ASL perfusion imaging was acquired, providing non-invasive information on cerebral perfusion. Continuous ECG monitoring, pulse oximetry, blood pressure measurements every 5 min, and short neurological assessments every 15 min were performed in every patient. Results: The median initial NIHSS score of the patients presenting with a mean of 84 min after onset was 4 (range 2-18). MRI examination was initiated within a mean of 45 min after arrival at the hospital. Five patients identified as stroke mimics were not treated with recombinant tissue plasminogen activator (rt-PA), and in 1 case with basilar artery occlusion bridging therapy was performed outside the scanner. In the remaining 10 patients, rt-PA therapy was started in the scanner directly after decision making on the basis of clinical information and baseline MRI. The mean door-to-needle time was 60 min (range 44-115) including approximately 10 min needed for acquiring informed consent. While 4 patients required antihypertensive treatment, no relevant complications were encountered. Conclusions: Fast and safe medical care in patients during systemic thrombolysis in the MRI scanner is feasible. Despite the process of obtaining informed consent, with a dedicated and experienced stroke team the door-to-needle time can be kept in a range recommended by current guidelines. Continuous real-time information about the dynamics of cerebral perfusion from ASL perfusion in acute stroke patients undergoing thrombolysis may provide additional information for the understanding of the events following acute arterial obstruction and its course.

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“…Perfusion imaging with arterial spin labeling (ASL) can visualize perfusion and quantify the cerebral blood flow using magnetically labeled arterial blood water protons as endogenous tracer particles [2,3]. The post-labeling delay time defines the time required for spins to travel from the labeling plane or volume to the imaged slide and is typically between 1,500 and 2,000 ms.…”

Section: Introductionmentioning

confidence: 99%

Intra-Arterial Signal on Arterial Spin Labeling Perfusion MRI to Identify the Presence of Acute Middle Cerebral Artery Occlusion

et al. 2014

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Background: The susceptibility vessel sign on gradient echo-type-T2*-weighted imaging is a well-known marker of arterial occlusion. Stagnant flow in front of the middle cerebral artery (MCA) occlusion sites may contribute to the intra-arterial, high-intensity signal on arterial spin labeling magnetic resonance imaging (MRI), making it another potential marker of MCA occlusion. We compared the intra-arterial, high-intensity signal and susceptibility vessel sign in patients with symptomatic MCA occlusion and patients without major vessel occlusion. Methods: We identified transient ischemic attack or ischemic stroke patients with (1) 3-T MRI performed within 24 h after clinical onset including arterial spin labeling, T2*-weighted imaging, and magnetic resonance angiography (MRA) and (2) either having MCA occlusion (n = 34 patients) or without major vessel occlusion (n = 24 patients). The intra-arterial, high-intensity signal was defined as an enlarged circular or linear bright hyperintensity within the artery. The susceptibility vessel sign was defined as an enlarged spot of hypointensity within the MCA, in which the diameter of the hypointense signal within the vessel exceeded the contralateral vessel diameter. The presence or absence of the intra-arterial, high-intensity signal and susceptibility vessel sign were assessed, along with their inter-rater agreement and consistency with the presence of MCA occlusion on MRA. Results: The intra-arterial, high-intensity signal was detectable in 30 patients (52%), and susceptibility vessel sign was observed in 17 patients (29%). The sensitivity of the intra-arterial high-intensity signal was significantly higher than that of the susceptibility vessel sign (88% vs. 50%; p < 0.05). The accuracy of the intra-arterial high-intensity signal was also higher than that of the susceptibility vessel sign (93% vs. 71%; p < 0.05). The intra-arterial high-intensity signal was situated in the proximal regions of the susceptibility vessel sign on T2*WI within the MCA. Neither the intra-arterial high-intensity signal nor the susceptibility vessel sign was observed in patients without major vessel occlusion. Inter-rater agreement was good for intra-arterial high-intensity signal detection (κ = 0.73) and moderate for susceptibility vessel sign detection (κ = 0.47). The presence or absence of the intra-arterial high-intensity signal was highly consistent with that of MCA occlusion on MRA (κ = 0.74). Conclusions: The intra-arterial high-intensity signal on arterial spin labeling appears to be useful to identify the presence of acute MCA occlusion and may be associated with stagnant flow in front of occlusion sites. The intra-arterial high-intensity signal may also be used to identify the occlusion site.

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Whole-Brain Arterial Spin Labeling Perfusion MRI in Patients With Acute Stroke

Cited by 100 publications

References 27 publications

Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic Stroke

Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic Stroke

Continuous Magnetic Resonance Perfusion Imaging Acquisition during Systemic Thrombolysis in Acute Stroke

Intra-Arterial Signal on Arterial Spin Labeling Perfusion MRI to Identify the Presence of Acute Middle Cerebral Artery Occlusion

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