Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke
Change in Cortical Vessel Signs on Susceptibility-Weighted Images after Full Recanalization in Hyperacute Ischemic Stroke
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DOI：
10.1159/000342148
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Jeong, Hae Woong
中科院分区：
文献类型：
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作者：
Baik, Seung Kug;Choi, Wonjin;Jeong, Hae Woong
背景：超急性缺血性卒中患者的磁共振加权成像（SWI）上出现皮质血管征（CVSs）已有报道。我们评估了完全再通后即刻SWI上该敏感性标志的变化及其临床意义。研究方法：本研究纳入了19例急性大动脉闭塞并接受再通后SWI的超急性缺血性卒中患者。患者有伊卡（颈内动脉，2例），M1大脑中动脉M1段7例，M2大脑中动脉M2段1例，T（颅内伊卡分叉2例）、伊卡/M1（4例）和基底动脉（3例）闭塞，并立即进行磁共振成像，包括SWI，完全再通后。采用溶栓前后脑梗死溶栓（TICI）评分评价再通情况。SWI图像评价了缺血区域静脉不对称的存在，这与狭窄或闭塞的部位相关。如果与对侧正常半球相比，观察到更多的静脉和/或大静脉具有更大的信号丢失，则缺血区域的静脉被归类为“突出”，如果两个大脑半球的外观没有显著差异，则被归类为“相等”，如果与正常皮质相比，受影响区域的静脉减少，则被归类为“较少”。对基线临床参数和临床结局进行了审查。结果：所有病例的初始TICI等级均为0。溶栓后，所有病例的TICI分级均为3级。19例患者中有10例获得了再通前SWI，所有10例患者的患侧均显示出明显的CVS，这些CVS在再通后SWI上消失。在再通后SWI上，观察到受累区域的静脉相等（10/19）、更少（5/19）和相等且更少（4/19）。病变区皮质静脉数量相等的患者在DWI上表现为小病灶（10/19），皮质静脉数量较少的患者在DWI上表现为中至大病灶（9/19）。结论：SWI上明显的CVSs可提示急性血栓栓塞性闭塞，再通后即刻CVSs的变化可反映代谢状态。再通后，SWI上出现相等的CVS（恢复正常）与良好的临床结局相关，在我们的小系列研究中避免了梗死。版权所有（C）2012 S. Karger AG，巴塞尔
Background: The cortical vessel signs (CVSs) on susceptibility-weighted images (SWIs) have been reported in patients with hyperacute ischemic stroke. We evaluated the change of this susceptibility sign on the immediate SWI after full recanalization and its clinical implications. Methods: Nineteen hyperacute ischemic stroke patients who had acute large artery occlusion and underwent post-recanalization SWI were enrolled in this study. The patients had ICA (internal carotid artery, 2 cases), M1 (M1 segment of middle cerebral artery, 7 cases), M2 (M2 segment of middle cerebral artery, 1 cases), T (intracranial ICA bifurcation, 2 cases), ICA/M1 (4 cases) and basilar artery (3 cases) occlusion on imaging studies before thrombolysis and they underwent immediate magnetic resonance imaging, including the SWI, after full recanalization. The recanalization status was evaluated using the thrombolysis in cerebral infarction (TICI) score before and after thrombolysis. The SWI images were evaluated for the presence of asymmetry of veins over the ischemic territory and this was correlated with the site of stenosis or occlusion. The veins in the ischemic territory were classified as 'prominent' if there were more numerous veins and/or large veins with a greater signal loss observed compared with the opposite normal hemisphere, 'equal' if there were no significant difference in appearance in both the cerebral hemispheres, and 'less' if the veins were decreased in the affected area as compared with that of the normal cortex. Baseline clinical parameters and clinical outcomes were reviewed. Results: The initial TICI grades were 0 in all cases. After thrombolysis, TICI grades were 3 in all cases. The pre-recanalization SWIs were obtained in 10 of 19 patients and all 10 showed prominent CVSs over the affected side, which disappeared on the post-recanalization SWI. On the post-recanalization SWI, the observed veins in the affected area were equal (10/19), less (5/19), and both equal and less (4/19). Patients with equal cortical veins in the affected area had small lesions on diffusion-weighted image (DWI) (10/19), while patients with less cortical veins had medium to large lesions on DWI (9/19). Conclusion: The prominent CVSs on SWI can be indicative of acute thromboembolic occlusion and its change immediately after recanalization can be used to reflect the metabolic status. After recanalization, the appearance of the equal CVS (return to normal) on SWI was associated with a favorable clinical outcome and infarction was avoided in our small series study. Copyright (C) 2012 S. Karger AG, Basel