Abstract
ObjectivesAsymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patientsMethodsTwenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS).ResultsIG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ2 = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (rs = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (rs = 0.788, p = 0.000)ConclusionA positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
Highlights
Arterial ischemic stroke (AIS) represents about 80% of all strokes and is one of the leading causes of mortality and morbidity worldwide
Prominent veins are a sign of reduced cerebral perfusion
Radiation exposure and the use of iodinated contrast media which is contraindicated in patients with history of an anaphylactic reaction and renal impairment, along with the improved magnetic resonance imaging speed has led to increased utilization of Magnetic resonance imaging (MRI)-based sequences including diffusion-weighted imaging (DWI) and dynamic susceptibility contrastenhanced (DSC) perfusion-weighted imaging (PWI) [4]
Summary
Arterial ischemic stroke (AIS) represents about 80% of all strokes and is one of the leading causes of mortality and morbidity worldwide. There are certain difficulties hindering the incorporation of DSC-PWI into the routine workup of patients with AIS including the need for well-trained medical or technical personnel to perform the required post-processing, and the necessary administration of an intravenous gadolinium-based contrast agent (GBCA) which is risky in patients with severe renal impairment denoted by glomerular filtration rate (GFR) levels below 30 ml/min. This is of particular importance in countries where renal failure is prevalent [6]. Arterial spin labeling (ASL) perfusion has been introduced as an alternative tool for assessing cerebral blood flow without the need for contrast administration, but currently it is limited to research purposes and is not widely used in mainstream clinical practice [6]
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