Abstract T P174: Intra-Arterial Signal on Arterial Spin Labeling Perfusion MRI Can Identify Stagnant Flow in Patients with Acute Middle Cerebral Artery Occlusion

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Junichiro Satomi ◽  
Yoshiteru Tada ◽  
Takashi Abe ◽  
Kazuyuki Kuwayama ◽  
Shu Sogabe ◽  
...  
Keyword(s):  
High Intensity ◽  
Arterial Spin Labeling ◽  
Arterial Occlusion ◽  
Spin Labeling ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
Asymptomatic Patients ◽  
Major Vessel ◽  
High Intensity Signal ◽  
Stagnant Flow

Introduction: T2*-weighted imaging (T2*WI) can detect acute endovascular clots by the susceptibility vessel sign (SVS). Stagnant flow in front of middle cerebral artery (MCA) occlusion sites may contribute to intra-arterial high-intensity signal on arterial spin labeling (ASL) magnetic resonance imaging (MRI), making it another potential marker of MCA occlusion. We compared intra-arterial high-intensity signal and SVS in patients with symptomatic and asymptomatic MCA occlusion and patients without major vessel occlusion. Methods: We identified transient ischemic attack or ischemic stroke patients by (a) 3-T MRI, diffusion-weighted imaging, ASL, T2*WI, and magnetic resonance angiography (MRA) performed within 24 h after stroke onset and (b) the presence of MCA occlusion (n=34 patients) or the absence of major vessel occlusion (n=24 patients). We included asymptomatic patients with MCA occlusion (n=6). The presence or absence of intra-arterial high-intensity signal and SVS was recorded as was its coincidence with the presence of MCA occlusion on MRA. Results: In patients with acute ischemic stroke the sensitivity of intra-arterial high-intensity signal was significantly higher than of the SVS (88% vs 50%; p<0.05). The accuracy of intra-arterial high-intensity signal was also higher than of the SVS (93% vs 71%; p<0.05). Neither the intra-arterial high-intensity signal nor the SVS was observed in patients without major vessel occlusion. The presence or absence of intra-arterial high-intensity signal was highly consistent with the presence or absence of MCA occlusion on MRA (κ=0.74). Positivity for the intra-arterial high signal was higher in symptomatic than asymptomatic patients with MCA occlusion (88% vs 17%; p<0.05), suggesting that acute rather than chronic arterial occlusion contributes to the visibility of the intra-arterial high-intensity signal. Conclusions: The intra-arterial high-intensity signal on ASL could identify stagnant flow in front of occlusion sites due to acute arterial occlusion.

scholarly journals Differences In High-Intensity Signal Volume Between Arterial Spin Labeling And Contrast-Enhanced T1-Weighted Imaging May Be Useful For Differentiating Glioblastoma From Brain Metastasis

2017 ◽  
Vol 64 (1.2) ◽  
pp. 58-63 ◽  
Author(s):  
Mungunbagana Ganbold, MD ◽  
Masafumi Harada, MD, PhD ◽  
Delgerdalai Khashbat, MD, PhD ◽  
Takashi Abe, MD, PhD ◽  
Teruyoshi Kageji, MD, PhD ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
High Intensity ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Contrast Enhanced ◽  
High Intensity Signal

scholarly journals Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (2) ◽  
pp. 564-567 ◽  
Author(s):  
Roh-Eul Yoo ◽  
Tae Jin Yun ◽  
Jung Hyo Rhim ◽  
Byung-Woo Yoon ◽  
Koung Mi Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Spin Labeling ◽  
Arterial Occlusion ◽  
Spin Labeling

Effects of intermittent reperfusion during temporal focal ischemia

1992 ◽  
Vol 77 (6) ◽  
pp. 911-916 ◽  
Author(s):  
Marc S. Goldman ◽  
Robert E. Anderson ◽  
Fredric B. Meyer
Keyword(s):  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Content Type ◽  
Mca Occlusion ◽  
Ischemic Period ◽  
Occlusion Technique ◽  
Barrier Breakdown ◽  
Aneurysm Repair ◽  
Blood Brain Barrier Breakdown

✓ There is controversy regarding the role of intermittent reperfusion employed as a cerebroprotective measure when temporary arterial occlusion is necessary during repair of difficult aneurysms. The intraluminal suture middle cerebral artery (MCA) occlusion technique was used in 23 Wistar rats under barbiturate anesthesia to induce 60, 90, or 120 minutes of uninterrupted MCA occlusion. The total infarcted areas obtained were compared to those occurring in 27 animals subjected to identical cumulative ischemic periods but with 5 minutes of reperfusion after every 10-minute ischemic period. The mean total infarcted areas in the groups with 60-minute (1.8 ± 0.89 sq mm), 90-minute (1.08 ± 1.02 sq mm), and 120-minute (8.72 ± 5.89 sq mm) intermittent reperfusion were significantly smaller than those occurring in the 60-minute (12.02 ± 3.10 sq mm), 90-minute (11.54 ± 2.68 sq mm), or 120-minute (30.43 ± 6.51 sq mm) control groups, respectively (p < 0.05). Furthermore, there was no difference in the occurrence of blood-brain barrier breakdown, intraparenchymal hemorrhage, hemispheric edema, or seizures between control and intermittent reperfusion groups. The results support the hypothesis that intermittent reperfusion is beneficial if vessel occlusion is required during aneurysm repair.

scholarly journals Collateral perfusion using arterial spin labeling in symptomatic versus asymptomatic middle cerebral artery stenosis

2017 ◽  
Vol 39 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Xin Lou ◽  
Xiaoxiao Ma ◽  
David S Liebeskind ◽  
Ning Ma ◽  
Chenglin Tian ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Spin Labeling ◽  
Three Dimensional ◽  
Spin Labeling ◽  
Asymptomatic Group ◽  
Asymptomatic Patients ◽  
The Difference ◽  
Continuous Arterial Spin Labeling ◽  
Antegrade Flow

The purpose was to assess the difference of collaterals in symptomatic versus asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis by comparing cerebral blood flow (CBF) at two post labeling delays (PLD) using three-dimensional pseudo-continuous arterial spin labeling (3D pCASL). Eighty-one patients (49 symptomatic and 32 asymptomatic) with unilateral MCA stenosis ≥50% who underwent pCASL with two PLDs were included. Mean CBF and CBF subtraction images between two PLDs of MCA territories were compared in symptomatic and asymptomatic groups, respectively. Compared with the asymptomatic group, patients with symptomatic MCA stenosis had significantly lower CBF in the MCA territory of stenotic side at each PLD. The CBF of stenotic territory showed greater increase than that of normal side from PLD 1.5 to 2.5 s. The CBF of asymptomatic MCA territory increased similarly with that of symptomatic MCA territory from PLD of 1.5 to 2.5 s in stenotic side, while symptomatic patients experienced significantly slower antegrade flow. On CBF subtraction images, asymptomatic patients showed larger volume of differences between PLD of 1.5 and 2.5 s compared with those of symptomatic patients ( p = 0.037). The results suggest that more robust collateral perfusion on two-delay 3D pCASL is present in asymptomatic patients compared with symptomatic patients.

scholarly journals Arterial Spin Labeling—Can Neurointerventionists Rely on This Novel Technique? A Case Series on Successful Use of Arterial Spin Labeling in Acute Stroke Imaging

2017 ◽  
Vol 01 (03) ◽  
pp. 144-149
Author(s):  
K. Rahul ◽  
P. Santhosh ◽  
M. Kumar ◽  
Pankaj Mehta ◽  
Mathew Cherian
Keyword(s):  
Acute Stroke ◽  
Arterial Spin Labeling ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Spin Labeling ◽  
Ischemic Penumbra ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Imaging ◽  
Noninvasive Imaging Technique

AbstractPresence of ischemic penumbra is the principal factor that decides the need for mechanical thrombectomy in acute stroke patients with large vessel occlusion. Our objective was to evaluate the usefulness of arterial spin labeling (ASL) in detecting diffusion perfusion mismatch and directing patients into mechanical thrombectomy. We retrospectively studied all patients with acute nonhemorrhagic stroke in the anterior circulation, who had undergone stroke imaging with ASL followed by mechanical thrombectomy from July 2016 to November 2016. Area of diffusion perfusion mismatch was graded semiquantitatively into three grades: small, medium, and large. Mismatch was compared with 30-day modified Rankin scale (mRS) score. Interpretable PASL-perfusion images were obtained in all patients. Diffusion perfusion mismatches were present in all patients. Out of six patients with good mRS score, five patients had large diffusion perfusion mismatch. Two out of three patients with poor mRS were secondary to failed recanalization, in spite of large mismatch. One out of nine patients had poor outcome as well as a small area of mismatch. ASL is a rapid noninvasive imaging technique in acute stroke that has got the potential to detect ischemic penumbra.

Abstract TMP2: Postoperative Luxury Perfusion on Arterial Spin Labeling MRI Indicates Reperfusion Injury and Hemorrhagic Complication After Endovascular Mechanical Thrombectomy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Eisaku Sadakata ◽  
Nobutaka Horie ◽  
Yoichi Morofuji ◽  
Yohei Tateishi ◽  
Tsuyoshi Izumo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Reperfusion Injury ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Minor Bleeding ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Intracranial Vessel ◽  
Hemorrhagic Complications ◽  
Luxury Perfusion

Background and Purpose: Endovascular thrombectomy is of benefit to most patients with acute ischemic stroke caused by major intracranial vessel occlusion. Reperfusion injury is, however, one of the critical complications after successful recanalization, which has not been fully evaluated. The aim of this prospective study was to assess the impact of hyper-intensity signal on postoperative arterial spin labeling (ASL) MR imaging on hemorrhagic complications and clinical outcome after endovascular treatment. Methods: Consecutive patients showing acute stroke with major intracranial vessel occlusion were prospectively analyzed. All the patients underwent endovascular thrombectomy, and MR imaging including ASL was performed at pre-, postoperative day 1 and day 7. Clinical and radiological outcomes were evaluated especially focusing on arterial spin labeling findings. Results: Of 81 patients, 21/81 (25.9%) showed hyper-intensity signal on ASL (ASL+) at postoperative day 1. There were no significant differences in baseline characteristics between the groups with and without ASL+, including preoperative NIH stroke scale, door to puncture time, occlusion vessel and TICI score. Interestingly, 15/21 (71.4%) patients developed minor bleeding or hemorrhagic changes in ASL+ group, which was detected only in 3/60 (5.0%) in ASL- group. Modified Rankin Scale was not different between the groups at postoperative day 90 under strict control of blood pressure. Multivariate regression analysis showed that ASL+ is significantly related to postoperative hemorrhagic complications (Adjusted OR: 21.68, P=0.004). Conclusions: Postoperative hyper-intensity signal on ASL MRI indicates vasoparalysis and luxury perfusion even successful recanalization after endovascular thrombectomy, which has a risk for hemorrhagic complications.

Abstract WP42: Prediction of Blood-brain Barrier Disruption and Intracerebral Hemorrhagic Infarction Using Arterial Spin-labeling MRI

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Takeya Niibo ◽  
Hajime Ohta ◽  
Shirou Miyata ◽  
Ichirou Ikushima ◽  
Kazuchika Yonenaga ◽  
...  
Keyword(s):  
Ct Scan ◽  
Blood Brain Barrier ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Hemorrhagic Transformation ◽  
Brain Barrier ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Blood Brain Barrier Disruption ◽  
Blood Brain

Background and Purpose: Arterial spin-labeling (ASL) MRI is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke (AIS). We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in AIS patients. Methods: In a retrospective study, ASL was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline MR angiography. All patients underwent angiographic procedures intended for endovascular therapy and a noncontrast CT scan immediately after treatment. BBB disruption was defined as a hyperdense lesion present on the posttreatment CT scan. A subacute MRI or CT scan was performed during the subacute phase to assess HTs. The relationship between HLs and BBB disruption and HT was examined using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) locations in the symptomatic hemispheres. Results: A HL was defined as a region where CBF relative ≥1.4 (CBF relative =CBF HL /CBF contralateral ). HLs, BBB disruption and HT were found in 9, 15, and 15 patients, respectively. Compared with the patients without HLs, the patients with HLs had a higher incidence of both BBB disruption (100% versus 37.5%, P=0.003) and HT (100% versus 37.5%, P=0.003). Based on the ASPECTS locations, 21 regions of interests (ROIs) displayed HLs. Compared with the ROIs without HLs, the ROIs with HLs had a higher incidence of both BBB disruption (42.8% versus 3.9%, P<0.001) and HT (85.7% versus 7.8%, P<0.001). Conclusion: HLs detected on pretreatment ASL maps may enable the prediction and localization of subsequent BBB disruption and HT.

scholarly journals Raw Arterial Spin Labeling Data Can Help Identify Arterial Occlusion in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (6) ◽  
Author(s):  
Michael Majer ◽  
Mehdi Mejdoubi ◽  
Mathieu Schertz ◽  
Sylvie Colombani ◽  
Alessandro Arrigo
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Spin Labeling ◽  
Arterial Occlusion ◽  
Spin Labeling

Abstract 2226: Predictors Of tPA Non-responders According To Location Of Vessel Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nuno Mendonça ◽  
David Rodríguez-Luna ◽  
Sandra Boned-Riera ◽  
Marta Rubiera ◽  
Marc Ribó ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
History Of ◽  
Hemodynamic Profile ◽  
Ica Stenosis ◽  
Selection Of Patients ◽  
Iv Tpa ◽  
Selection Of

Background and purpose: Information on the clinical and hemodynamic profile of IV tPA non-responders, at different location of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aimed to investigate predictors of failing IV tPA therapy according to occluded vessel and location of clot. Methods: We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred and forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal MCA occlusion (n=251), distal MCA occlusion (n=194), ICA T occlusion (n=61) and BA occlusion (n=42). Recanalization was assessed on TCD at 1 hour of tPA bolus. Results: Among patients with proximal MCA occlusion, the presence of severe extracranial ICA stenosis or occlusion (OR 2.36, 95% CI 1.15-4.84, p=0.02) and age >74 years (OR 1.84, 95% CI 1.02-3.31, p=0.04) independently predicted no recanalization (NR). No independent predictors of NR were identified in patients with distal MCA occlusion. In patients with ICA T occlusion, history of hypertension (OR 12.77, 95% CI 2.12-76.88, p=0.05) and absence of atrial fibrillation (OR 0.12, 95% CI 0.02-0.71, p=0.02) emerged as independent predictors of NR. Similarly, among patients with BA occlusion, atrial fibrillation was as an independent predictor of NR (OR 0.13, 95% CI 0.03-0.72, p=0.02). Conclusions: Absence of atrial fibrillation independently predicts persistent occlusion at 1-h after tPA bolus in patients with ICA T and BA occlusions. The use of relevant predictors of NR and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.

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