Sulcal Effacement With Preserved Gray–White Junction

Abstract

Background and Purpose— Sulcal effacement with preserved underlying gray–white matter junction (isolated sulcal effacement [ISE]) in acute ischemic stroke may not represent irreversible parenchymal injury. We aimed to evaluate the frequency and significance of ISE in patients with large vessel occlusion acute ischemic stroke. Methods— Consecutive acute ischemic stroke patients with middle cerebral artery M1 or internal carotid artery terminus occlusions who underwent computed tomography angiogram/perfusion followed by intra-arterial therapy were screened for ISE. Results— Out of the 568 patients who underwent intra-arterial therapy between March 2011 and September 2014, 108 fulfilled inclusion criteria. ISE was present in 8 (7.4%) patients (age 55.7±10.5 years, 6 female, baseline National Institutes of Health Stroke Scale 16.1±3.8, 5 middle cerebral artery-M1, and 3 internal carotid artery terminus occlusions). Computed tomography angiogram revealed engorged/dilated leptomeningeal vessels obliterating the sulci within the areas of effacement, whereas computed tomography perfusion indicated normal-to-increased cerebral blood volume and prolonged T max in all patients. Modified treatment in cerebral ischemia (mTICI) 2b-3 reperfusion was achieved in all patients. Follow-up imaging confirmed no infarct in the ISE area in all patients, and 5 (62%) had modified Rankin Scale 0 to 2 at 3 months. Conclusions— Sulcal effacement with preserved gray–white delineation is occasionally visualized in patients with proximal occlusion strokes, relates to robust leptomeningeal collaterals, and indicates preserved underlying parenchyma. ISE should not be used to exclude patients from thrombectomy.

Interexpert agreement between neuroradiologists in the diagnosis of middle cerebral artery stroke by computed tomography

“…Однако D. Haussen и соавт. в своем исследовании подтвердили, что, несмотря на общепринятую трактовку значения данного признака, сглаженность борозд без ассоциированного нарушения дифференцировки серого и белого вещества не может интерпретироваться как признак ишемических изменений, а также учитываться при оценке по ASPECTS, посколь ку является потенциально обратимым явлением за счет повышенного лептоменингеального коллатерального кровотока [15]. С учетом отсутствия конвенционального подхода в определении данного признака именно он может вызывать наи большую вариативность при оценке КТ-признаков ишемического инсульта врачамирентгенологами.…”