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

Verma, Rajeev; Hsieh, Kety; Gratz, Pascal P.; Schankath, Adrian; Mordasini, Pasquale; Zubler, Christoph; Kellner-Weldon, Frauke; Jung, Simon; Schroth, Gerhard; Gralla, Jan; El-Koussy, Marwan

doi:10.1016/j.ejrad.2014.05.001

Cited by 46 publications

(58 citation statements)

References 30 publications

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“…They suggested that SWI can be an alternative to PWI to access penumbra [3]. Verma et al reported that both SWI and PWI can reflect ischemic tissue at risk but SWI cannot replace PWI because of the lower detection rate of MHV on SWI than MTT [8]. In our study, TTP lesion volumes were not correlated with the grade of MHV.…”

Section: Discussionmentioning

confidence: 31%

“…SWI is very sensitive to intravascular venous deoxygenated blood as well as extravascular blood products [1,2]. Cerebral veins on SWI can be seen more prominently as multiple hypointense vessels (MHV) in acute ischemic cerebral hemisphere [1,2,3,4,5,6,7,8,9]. Previous studies have suggested that MHV on SWI may be related with hypoperfusion or collateral flow in cerebral ischemia [3,4,5,6,7,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Multiple Hypointense Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke: Surrogate Marker of Oxygen Extraction Fraction in Penumbra?

Park

Yang²,

Oh³

et al. 2014

Cerebrovasc Dis

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Background: Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) are frequently observed in patients with acute cerebral ischemia, but their implication has not been clearly established. To elucidate the clinical significance of MHV on SWI, we investigated the association of MHV on SWI with clinical data and other MR markers in patients with acute ischemic stroke. Methods: We enrolled acute stroke patients with internal carotid or proximal middle cerebral artery occlusion who underwent MRI including SWI within 3 days from stroke onset. Baseline clinical data were reviewed. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). We graded the degree of MHV on SWI as four groups of none, subtle, relative, or extensive by the modified Alberta Stroke Program Early CT Scan (ASPECTS) system. To evaluate the degree of collateral flow, distal hyperintense vessels (DHV) on FLAIR and vessels on post-contrast time-of-flight MR angiography (TOF MRA) source images were graded respectively as 3 groups: none/subtle/prominent and poor/moderate/good. Diffusion and perfusion lesion volume and diffusion-perfusion mismatch (DPM) ratio were measured in all patients. We analyzed the association of the degree of MHV on SWI with clinical data and MR markers. Results: Eighty patients were included in the study. The mean MR time from stroke onset was 12.4 h (range 0.5-63.0). There is no difference in MR time from stroke onset between groups of MHV on SWI. MHV were observed in 68 (85%) of 80 patients: none in 12, subtle in 11, relative in 13, and extensive in 44. There were no statistically significant associations between MHV on SWI and vascular risk factors. Patients with more extensive MHV on SWI had a smaller diffusion volume (p < 0.001), larger DPM (p < 0.001), and lower initial NIHSS scores (p = 0.022). Prominent DHV was presented in 29 of 44 patients with extensive MHV (p < 0.001). Good collateral flow on TOF MRA source images was presented in 37 of 44 patients with extensive MHV (p < 0.001). Conclusions: More extensive MHV on SWI in acute ischemic stroke is associated with lower initial NIHSS scores, smaller diffusion lesion volume, better collateral flow, and larger DPM. Our results show the possibility that MHV on SWI may be a useful surrogate marker for predicting increased oxygen extraction fraction and diffusion-perfusion mismatch in acute ischemic hemisphere.

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Section: Discussionmentioning

confidence: 31%

Section: Introductionmentioning

confidence: 99%

Multiple Hypointense Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke: Surrogate Marker of Oxygen Extraction Fraction in Penumbra?

Park

Yang²,

Oh³

et al. 2014

Cerebrovasc Dis

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“…Recent studies interpreted the presence of extensive prominent cortical vessels and asymmetry of deep medullary veins after AIS as evidence of poor leptomeningeal collateralization, because good collateralization should lead to less deoxygenated blood in the veins. [22][23][24] Collateral status is one of the most important factors determining penumbral tissue loss, and good collaterals have been associated with reduced penumbral loss. 13,25 Therefore, we speculated that the presence of IPTSV might indicate poor collaterals after acute ischemia, which would result in increased penumbral tissue loss.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke

Zhang¹,

Zhang²,

Chen³

et al. 2017

AJNR Am J Neuroradiol

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“…A 0-3 scoring system was used for the evaluation of prominence grades akin to prior studies: 0 5 none, 1 5 mild, 2 5 moderate and 3 5 distinct prominence ( Figure 1). 9,10,12 Arterial occlusion was determined on time-of-flight MRA obtained at the same time as SWI, or-if unavailable-on CTA performed within 3 h of the MRI examination. The diffusion-weighted imaging infarct lesion volumes were manually segmented and measured using the MRIcron software (McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC).…”

Section: Image Analysismentioning

confidence: 99%

“…11 Prominent veins on SWI are thought to represent either ischaemic penumbra or poor collateralization of arterial supply. 1,9,12,13 However, the appearance of prominent cortical and medullary veins seems to be pathophysiologically complex; thus, their clinical significance remains elusive.…”

Section: Introductionmentioning

confidence: 99%

Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke

Payabvash¹,

Benson²,

Taleb³

et al. 2016

The British Journal of Radiology

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Objective: To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke. Methods: Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined. Results: Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k 5 0.314-0.338, p # 0.001) for grading, and moderate agreement (k 5 0.406-0.413, p # 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho 5 0.232, p 5 0.001; rho 5 0.180, p 5 0.008; respectively) and larger infarct volume (rho 5 0.445, p , 0.001; rho 5 0.167, p 5 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p 5 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p , 0.001). Conclusion: There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).

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

Cited by 46 publications

References 30 publications

Multiple Hypointense Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke: Surrogate Marker of Oxygen Extraction Fraction in Penumbra?

Multiple Hypointense Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke: Surrogate Marker of Oxygen Extraction Fraction in Penumbra?

Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke

Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke

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