Cargando…

Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging

OBJECTIVES: Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute str...

Descripción completa

Detalles Bibliográficos
Autores principales: Darwish, Eman A. F., Abdelhameed-El-Nouby, Maha, Geneidy, Eman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955386/
https://www.ncbi.nlm.nih.gov/pubmed/31930428
http://dx.doi.org/10.1186/s13244-019-0810-y
_version_ 1783486926906458112
author Darwish, Eman A. F.
Abdelhameed-El-Nouby, Maha
Geneidy, Eman
author_facet Darwish, Eman A. F.
Abdelhameed-El-Nouby, Maha
Geneidy, Eman
author_sort Darwish, Eman A. F.
collection PubMed
description OBJECTIVES: Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patients METHODS: Twenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS). RESULTS: IG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ(2) = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (r(s) = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (r(s) = 0.788, p = 0.000) CONCLUSION: A positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
format Online
Article
Text
id pubmed-6955386
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-69553862020-01-27 Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging Darwish, Eman A. F. Abdelhameed-El-Nouby, Maha Geneidy, Eman Insights Imaging Original Article OBJECTIVES: Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patients METHODS: Twenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS). RESULTS: IG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ(2) = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (r(s) = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (r(s) = 0.788, p = 0.000) CONCLUSION: A positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated. Springer Berlin Heidelberg 2020-01-13 /pmc/articles/PMC6955386/ /pubmed/31930428 http://dx.doi.org/10.1186/s13244-019-0810-y Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Darwish, Eman A. F.
Abdelhameed-El-Nouby, Maha
Geneidy, Eman
Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title_full Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title_fullStr Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title_full_unstemmed Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title_short Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
title_sort mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955386/
https://www.ncbi.nlm.nih.gov/pubmed/31930428
http://dx.doi.org/10.1186/s13244-019-0810-y
work_keys_str_mv AT darwishemanaf mappingtheischemicpenumbraandpredictingstrokeprogressioninacuteischemicstroketheoverlookedroleofsusceptibilityweightedimaging
AT abdelhameedelnoubymaha mappingtheischemicpenumbraandpredictingstrokeprogressioninacuteischemicstroketheoverlookedroleofsusceptibilityweightedimaging
AT geneidyeman mappingtheischemicpenumbraandpredictingstrokeprogressioninacuteischemicstroketheoverlookedroleofsusceptibilityweightedimaging