Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Rudilosso, Salvatore; Laredo, Carlos; Mancosu, M; Moya-Planas, Nuria; Zhao, Yashu; Chirife, Oscar; Chamorro, Ángel; Urra, Xabier

doi:10.1177/0271678x18758548

Cited by 19 publications

(16 citation statements)

References 51 publications

(50 reference statements)

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“…We speculated that perfusion abnormalities demonstrated on the ASL maps in the acute phase in our series may be explained by the presence of reduced blood supply in the setting of nonocclusive hypoxic-ischaemic encephalopathy. 24,[29][30][31] Finally, we acknowledge the several limitations of this study, most notably related to the retrospective study design and to the small number of patients included. However, the latter reflects the rarity of CLN in clinical practice, especially in the acute phase in the postoperative setting.…”

Section: Discussionmentioning

confidence: 99%

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Cannella

Sparacia

et al. 2019

Neuroradiol J

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Purpose The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery. Materials and methods This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm2) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four patients. Conventional and advanced magnetic resonance images were analysed to assess the imaging features in acute stage cortical laminar necrosis. Results The final population consisted of 14 patients (seven men and seven women, mean age 61 years, range 32–79 years) diagnosed with stroke and acute phase cortical laminar necrosis. All the patients presented with cortical lesions showing restricted diffusion on diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. Cortical hyperintensity on T2-weighted or fluid-attenuated inversion recovery images was found in three (21%) and six (43%) patients, respectively. Reduced perfusion was noted in three out of four patients imaged with arterial spin labelling, while in one case no corresponding perfusion abnormality was noted on the arterial spin labelling maps. Arterial spin labelling abnormalities were much more extensive than diffusion restriction in two patients, and they were associated with a poor outcome. Conclusion Cortical hyperintense abnormalities on diffusion-weighted imaging may be the only sign of developing cortical laminar necrosis injury. The acquisition of arterial spin labelling helps to identify perfusion alterations and the extension of the ischaemic injury.

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Section: Discussionmentioning

confidence: 99%

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Cannella

Sparacia

et al. 2019

Neuroradiol J

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“…26,27 However, recent studies using dynamic 4-dimentional angiography derived from perfusion CT acquisitions have visualized collateral flow in SSIs, with compensatory blood supply to the ischemic area from adjacent perforator arteries. 20,28 Moreover, CSVD has now been recognized to reflect whole-brain endothelial dysfunction, which is strongly correlated with loss of brain reactivity, and is reflected by a more globally compromised CBF. 29 Therefore, the higher hemispheric CBF seen in our study might also reflect better 'collateral reserve' in patients with SSIs, and hence the association with better clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, this sample size is comparable with similar studies. 20,28 Second, the perfusion changes before or after rtPA was measured in different patients with only one perfusion imaging scan. It would be ideal to perform perfusion imaging before and after rtPA, but this is not considered routine care due to radiation dose.…”

Section: Discussionmentioning

confidence: 99%

“…Since previous studies of perfusion patterns of SSIs only used visual inspection or primary qualitative analysis through co-registration of perfusion and follow-up imaging, [20][21][22][23][24][25] the necessity of a study with accurate co-registration and quantitative calculation was warranted. Through an analysis using accurate co-registration of baseline perfusion imaging and follow-up magnetic resonance imaging (MRI), we tested the hypothesis that higher hemispheric CBF was associated with a better clinical outcome in SSIs, and had an interaction with the effect of intravenous rtPA.…”

Section: Introductionmentioning

confidence: 99%

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Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts

Hong

Ling

et al. 2021

J Cereb Blood Flow Metab

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The association between baseline perfusion measures and clinical outcomes in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. Post-processed acute perfusion CT and follow-up diffusion-weighted imaging of 71 patients with SSIs were accurately co-registered. Relative perfusion values were calculated from the perfusion values of the infarct lesion divided by those of the mirrored contralateral area. The association between perfusion measures with clinical outcomes and the interaction with intravenous thrombolysis were studied. Additionally, the perfusion measures for patients having perfusion CT before and after thrombolysis were compared. Higher contralateral hemispheric cerebral blood flow (CBF) was the only independent predictor of an excellent clinical outcome (modified Rankin Scale of 0-1) at 3 months (OR = 1.3, 95% CI 1.1–1.4, P = 0.001) amongst all the perfusion parameters, and had a significant interaction with thrombolysis (P = 0.04). Patients who had perfusion CT after thrombolysis demonstrated a better perfusion profile (relative CBF ≥1) than those who had perfusion CT before thrombolysis (After:45.5%, Before:21.1%, P = 0.03). This study implies that for patients with SSIs, hemispheric CBF is a predictor of clinical outcome and has an influence on the effect of intravenous thrombolysis.

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“…Forster et al first observed anterograde and retrograde collaterals in acute lacunar infarction using 4D dynamic susceptibility contrast (DSC) MR perfusion [13]. Rudilosso et al used CT perfusion to demonstrate that there was delayed compensatory collateral supply in recent SSI [14]. However, they did not show clinically significant differences between the collateral flow patterns.…”

Section: Introductionmentioning

confidence: 99%

Perfusion Defects and Collateral Flow Patterns in Acute Small Subcortical Infarction: a 4D Dynamic MRI Study

Huang

Lee

Pan

et al. 2021

Transl. Stroke Res.

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The hemodynamic changes of acute small subcortical infarction (SSI) are not well understood. We evaluate the hemodynamic changes and collaterals in acute SSI using perfusion magnetic resonance imaging (MRI). A total of 103 patients with acute SSI in penetrating artery territories were recruited and underwent MRI within 24 h of stroke onset. Using 4D dynamic perfusion MRI, they were divided into three patterns: 25 (24%) with normal perfusion, 31 (30%) with compensated perfusion, and 47 (46%) with hypoperfusion. The development of anterograde or retrograde collaterals was also evaluated. Patients with hypoperfusion pattern had the highest rate of early neurological deterioration (32%, p = 0.007), the largest initial and final infarction volumes (p < 0.001 and p = 0.029), the lowest relative cerebral blood flow (0.63, p < 0.001), and the lowest rate of anterograde and retrograde collaterals (19%, p < 0.001; 66%, p = 0.002). The anterograde collaterals were associated with higher relative cerebral blood volume (0.91 vs. 0.77; p = 0.024) and a higher rate of deep cerebral microbleeds (48 vs. 21%; p = 0.028), whereas retrograde collaterals were associated with higher systolic and diastolic blood pressure (p = 0.031 and 0.020), smaller initial infarction volume (0.81 vs. 1.34 ml, p = 0.031), and a higher rate of lobar cerebral microbleeds (30 vs. 0%; p = 0.013). Both anterograde and retrograde collaterals may play a critical role in maintaining cerebral perfusion and can have an impact on patient clinical outcomes. Further studies are warranted to verify these findings and to investigate effective treatments.

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Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Cited by 19 publications

References 51 publications

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts

Perfusion Defects and Collateral Flow Patterns in Acute Small Subcortical Infarction: a 4D Dynamic MRI Study

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