Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals.

Verma, Rajeev Kumar; Gralla, Jan; Klinger-Gratz, Pascal Pedro; Schankath, Adrian Clemens; Jung, Simon; Mordasini, Pasquale; Zubler, Christoph; Arnold, Marcel; Bühlmann, Monika; Lang, Matthias F; El-Koussy, Marwan; Hsieh, Kety Wha-Vei (2015). Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals. PLoS ONE, 10(9), e0137292. Public Library of Science 10.1371/journal.pone.0137292

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The aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS).


Seventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI) and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS). Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group) and 45 subjects with grade 1 or 2 (poorly-collateralized group). Individual ASPECTS areas were compared among the groups.


Means for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively), and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088). Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.


Patients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Verma, Rajeev Kumar, Gralla, Jan, Schankath, Adrian Clemens, Jung, Simon, Mordasini, Pasquale Ranato, Zubler, Christoph, Arnold, Marcel, Bühlmann, Monika, El-Koussy, Marwan, Hsieh, Kety Wha-Vei


600 Technology > 610 Medicine & health




Public Library of Science




Valentina Rossetti

Date Deposited:

30 Sep 2015 13:41

Last Modified:

02 Mar 2023 23:26

Publisher DOI:


PubMed ID:





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