Early Basal Ganglia Hyperperfusion on CT Perfusion in Acute Ischemic Stroke: A Marker of Irreversible Damage?

Shahi, Varun; Fugate, Jennifer E.; Kallmes, David F.; Rabinstein, A.A.

doi:10.3174/ajnr.a3935

Cited by 8 publications

(13 citation statements)

References 14 publications

(16 reference statements)

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“…The former implies excessive CBF, the second suggests the CBF return to physiologic value, while the last closely relates to a tissue state characterized by a CBF in excess of cellular metabolic demand . Furthermore, hyperperfusion was observed both spontaneously or after revascularization procedures . Some studies associated this phenomenon with rapid clinical recovery or better outcome .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies associated this phenomenon with rapid clinical recovery or better outcome . On the contrary, other studies have shown that hyperperfusion can lead to brain infarction or hemorrhage . Hyperperfusion was also related with two different uncommon phenomena both with negative outcome referred as cerebral hyperperfusion syndrome, mainly reported after carotid endarterectomy, and reperfusion injury mostly associated with arterial thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

“…2 Furthermore, hyperperfusion was observed both spontaneously or after revascularization procedures. [3][4][5][6][7][8][9] Some studies associated this phenomenon with rapid clinical recovery or better outcome. [6][7][8] On the contrary, other studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) .0003 <.0001 Discharge 3.0 (0-7) 6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) .009 .62 1-month follow-up 0 (0-6) 6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)…”

Section: Discussionmentioning

confidence: 99%

“…This overabundant cerebral blood flow (CBF), to which we will refer as regional hyperperfusion (RH), can reach values as high as twice those of baseline . A number of studies, with mixed results, were carried out to establish the significance of the cerebral hyperperfusion after recanalization procedures . Only a few authors have investigated RH .…”

Section: Introductionmentioning

confidence: 99%

“…2 A number of studies, with mixed results, were carried out to establish the significance of the cerebral hyperperfusion after recanalization procedures. [3][4][5][6] Only a few authors have investigated RH. [7][8][9] These studies, based on the single photon emission computed tomography or positron emission computed tomography, suggest that when observed 5-18 hours after stroke onset, RH is a marker of favorable tissue outcome.…”

Section: Introductionmentioning

confidence: 99%

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Arterial Spin Labeling MRI to Measure Cerebral Blood Flow in Untreated Ischemic Stroke

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2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSE This study aims to investigate the significance of regional hyperperfusion (RH) detected by arterial spin labeling (ASL) in a group of untreated stroke patients, within 24‐36 hours after symptom onset. The relationship between RH volume and infarcted volume (DIV) as defined on diffusion weighted images (DWIs) was evaluated. METHODS Of the 346 consecutive acute stroke patients who attended our center, we retrospectively reviewed MRI studies of 47 patients who were ineligible for standard treatment with intravenous tissue plasminogen activator. The MRI study included ASL and DWI. The ASL‐derived cerebral blood flow (CBF) maps were coregistered on the DWI images. RH volume and DIV were calculated and compared. Patient NIHSS scores were also evaluated at admission, discharge, and after 1 and 6‐month follow‐up. RESULTS Twenty‐two patients showed RH with CBF twice than baseline. In all 22 patients, RH overlaps with DWI infarcted area. No significant difference (P = .94) between RH volume and DIV was found (7.2 ± 9.6 and 9.0 ± 11.9 cm3). The Pearson's correlation coefficient between RH and DIV was .93. On univariate analysis, a significant difference was found between patient's groups on NIHSS at any time points, after covariates adjustment NIHSS difference was significant only at admission. CONCLUSIONS The study showed that ASL perfusion could be an integral part of the MRI examination in the assessment of 24‐36 hours not‐treated stroke patients as sustained RH group had improved outcomes. More importantly, ASL perfusion may provide evidence of beneficial effects of reperfusion induced by recanalization treatment.

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Section: Discussionmentioning

confidence: 99%