Assessment of veins in T2*-weighted MR angiography predicts infarct growth in hyperacute ischemic stroke.

Susumu Yamaguchi,Yoichi Morofuji,Minoru Morikawa,Takeshi Hiu,Tsuyoshi Izumo,Nobutaka Horie,Kentaro Hayashi,Yohei Tateishi,Takayuki Matsuo

doi:10.1371/journal.pone.0195554

Susumu Yamaguchi, Yoichi Morofuji + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0195554

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Journal: PloS one	Publication Date: Apr 4, 2018
Citations: 4	License type: CC BY 4.0

Affiliation: Nagasaki University

Abstract

Background and purposeT2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS).Materials and methodsMagnetic resonance imaging (MRI) records—including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)—of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed. Acute recanalization was defined as an arterial occlusive lesion score of 2–3. A modified Alberta Stroke Program Early CT Score (mASPECTS) was used to evaluate ischemic areas revealed by SWAN and DWI. SWAN- and DWI-based mASPECTSs were calculated, and correlations between DWI-SWAN mismatches with final infarct lesions or clinical outcomes were evaluated.ResultsAmong the 35 patients included in this study, we confirmed cardioembolic stroke in 26, atherothrombotic stroke in 4, and unknown stroke etiology in 5. Overall, recanalization was achieved in 23 patients, who showed a higher follow-up DWI-based mASPECTS and lower modified Rankin Scale (mRS) score at 90 days than patients without recanalization. Initial SWAN- and follow-up DWI-based mASPECTSs were significantly higher for atherothrombotic stroke than for cardioembolic stroke. Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth. Patients with recanalization showed no such correlation. In the assessment of clinical outcome, follow-up DWI-based mASPECTS and patient's age were significantly correlated with mRS at 90 days after stroke. A multivariate logistic regression analysis revealed that the follow-up DWI-based mASPECTS was independently associated with a favorable outcome 90 days after stroke.ConclusionsFor patients with AIS, DWI-SWAN mismatch might show penumbra-like lesions that would predict infarct growth without acute recanalization. Assessment of ischemic lesions from the venous side appears to be useful for considering the etiology and revascularization therapy.

Highlights

Treatment for patients with acute ischemic stroke (AIS) has recently made remarkable progress with the development of endovascular devices
Recanalization was achieved in 23 patients, who showed a higher follow-up diffusion-weighted imaging (DWI)-based mASPECTS and lower modified Rankin Scale score at 90 days than patients without recanalization
Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth

Summary

Introduction

Treatment for patients with acute ischemic stroke (AIS) has recently made remarkable progress with the development of endovascular devices. [3] The DEFUSE 3 study showed significant benefits of mechanical thrombectomy compared with medical therapy alone for patients with AIS 6–16 h after stroke onset [4] These results could widen the treatment indications for AIS. Current methods for ischemic penumbra evaluation include positron emission tomography (PET), single photon emission computed tomography, and contrast-enhanced perfusion imaging by computed tomography (CT) or magnetic resonance imaging (MRI). These methods, are costly, and the use of contrast medium sometimes poses risks of allergy and renal impairment. We investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS)

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