Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging.

Verma, Rajeev Kumar; Hsieh, Kety Wha-Vei; Gratz, Pascal P; Schankath, Adrian C; Mordasini, Pasquale; Zubler, Christoph; Kellner-Weldon, Frauke; Jung, Simon; Schroth, Gerhard; Gralla, Jan; El-Koussy, Marwan (2014). Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging. European journal of radiology, 83(8), pp. 1448-1454. Elsevier 10.1016/j.ejrad.2014.05.001

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BACKGROUND

The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings.

METHODS

33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented.

RESULTS

20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p=0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p<0.00).

CONCLUSIONS

In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill-perfused areas than SWI, especially in good collateralized subjects.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
UniBE Contributor:	Verma, Rajeev Kumar, Hsieh, Kety Wha-Vei, Mordasini, Pasquale Ranato, Zubler, Christoph, Kellner-Weldon, Frauke, Jung, Simon, Schroth, Gerhard, Gralla, Jan, El-Koussy, Marwan
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0720-048X
Publisher:	Elsevier
Language:	English
Submitter:	Martin Zbinden
Date Deposited:	10 Oct 2014 22:21
Last Modified:	02 Mar 2023 23:25
Publisher DOI:	10.1016/j.ejrad.2014.05.001
PubMed ID:	24882785
Uncontrolled Keywords:	Acute ischemic stroke, Leptomeningeal collateralization, Perfusion-weighted imaging, Prominent cortical veins, Susceptibility-weighted imaging
URI:	https://boris.unibe.ch/id/eprint/54021