Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Perfusion-Weighted MRI Parameters for Prediction of Early Progressive Infarction in Middle Cerebral Artery Occlusion

  • Kim, Hoon (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yerim (Department of Neurology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young Woo (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Seong Rim (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yang, Seung Ho (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2015.08.20
  • Accepted : 2016.02.26
  • Published : 2016.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. Methods : We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ${\geq}2$ points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. Results : Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI. Conclusion : The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.

Keywords

References

  1. Alawneh JA, Moustafa RR, Baron JC : Hemodynamic factors and perfusion abnormalities in early neurological deterioration. Stroke 40 : e443-e450, 2009 https://doi.org/10.1161/STROKEAHA.108.532465
  2. Birschel P, Ellul J, Barer D : Progressing stroke : towards an internationally agreed definition. Cerebrovasc Dis 17 : 242-252, 2004 https://doi.org/10.1159/000076161
  3. Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, et al. : Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 42 : 3435-3440, 2011 https://doi.org/10.1161/STROKEAHA.111.618355
  4. Campbell BC, Christensen S, Tress BM, Churilov L, Desmond PM, Parsons MW, et al. : Failure of collateral blood flow is associated with infarct growth in ischemic stroke. J Cereb Blood Flow Metab 33 : 1168-1172, 2013 https://doi.org/10.1038/jcbfm.2013.77
  5. Davalos A, Cendra E, Teruel J, Martinez M, Genis D : Deteriorating ischemic stroke : risk factors and prognosis. Neurology 40 : 1865-1869, 1990 https://doi.org/10.1212/WNL.40.12.1865
  6. Desilles JP, Meseguer E, Labreuche J, Lapergue B, Sirimarco G, Gonzalez-Valcarcel J, et al. : Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis : a registry and systematic review. Stroke 44 : 1915-1923, 2013 https://doi.org/10.1161/STROKEAHA.111.000813
  7. Eusebi P : Diagnostic accuracy measures. Cerebrovasc Dis 36 : 267-272, 2013 https://doi.org/10.1159/000353863
  8. Hjalmarsson C, Manhem K, Bokemark L, Andersson B : The role of prestroke glycemic control on severity and outcome of acute ischemic stroke. Stroke Res Treat 2014 : 694569, 2014
  9. Horiuchi T, Nitta J, Ishizaka S, Kanaya K, Yanagawa T, Hongo K : Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke. Neurosurg Rev 36 : 559-564; discussion 564-565, 2013 https://doi.org/10.1007/s10143-013-0487-5
  10. Hou Q, Zuo Z, Michel P, Zhang Y, Eskandari A, Man F, et al. : Influence of chronic hyperglycemia on cerebral microvascular remodeling : an in vivo study using perfusion computed tomography in acute ischemic stroke patients. Stroke 44 : 3557-3560, 2013 https://doi.org/10.1161/STROKEAHA.113.003150
  11. Jia Q, Zhao X, Wang C, Wang Y, Yan Y, Li H, et al. : Diabetes and poor outcomes within 6 months after acute ischemic stroke : the China National Stroke Registry. Stroke 42 : 2758-2762, 2011 https://doi.org/10.1161/STROKEAHA.111.621649
  12. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS : Effect of blood pressure and diabetes on stroke in progression. Lancet 344 : 156-159, 1994 https://doi.org/10.1016/S0140-6736(94)92757-X
  13. Kawai N, Keep RF, Betz AL : Hyperglycemia and the vascular effects of cerebral ischemia. Acta Neurochir Suppl 70 : 27-29, 1997
  14. Khatri R, Rodriguez GJ, Suri MF, Vazquez G, Ezzeddine MA : Leptomeningeal collateral response and computed tomographic perfusion mismatch in acute middle cerebral artery occlusion. J Vasc Interv Neurol 4 : 1-4, 2011
  15. Kimura K, Sakamoto Y, Iguchi Y, Shibazaki K, Aoki J, Sakai K, et al. : Admission hyperglycemia and serial infarct volume after t-PA therapy in patients with and without early recanalization. J Neurol Sci 307 : 55-59, 2011 https://doi.org/10.1016/j.jns.2011.05.017
  16. Kluytmans M, van Everdingen KJ, Kappelle LJ, Ramos LM, Viergever MA, van der Grond J : Prognostic value of perfusion- and diffusionweighted MR imaging in first 3 days of stroke. Eur Radiol 10 : 1434-1441, 2000 https://doi.org/10.1007/s003300000501
  17. Kwan J, Hand P : Early neurological deterioration in acute stroke : clinical characteristics and impact on outcome. QJM 99 : 625-633, 2006 https://doi.org/10.1093/qjmed/hcl082
  18. Lee SB, Huh PW, Kim DS, Yoo DS, Lee TG, Cho KS : Early superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke. Clin Neurol Neurosurg 115 : 1238-1244, 2013 https://doi.org/10.1016/j.clineuro.2012.11.022
  19. Lee SY, Cha JK, Kang MJ : Regional cerebral blood volume ratio on perfusion MRI on the growth of infarct size in acute ischemic stroke. Eur Neurol 62 : 281-286, 2009 https://doi.org/10.1159/000235597
  20. Lemkes BA, Hermanides J, Devries JH, Holleman F, Meijers JC, Hoekstra JB : Hyperglycemia : a prothrombotic factor? J Thromb Haemost 8 : 1663-1669, 2010 https://doi.org/10.1111/j.1538-7836.2010.03910.x
  21. Liu Y, Karonen JO, Vanninen RL, Nuutinen J, Koskela A, Soimakallio S, et al. : Acute ischemic stroke : predictive value of 2D phase-contrast MR angiography--serial study with combined diffusion and perfusion MR imaging. Radiology 231 : 517-527, 2004 https://doi.org/10.1148/radiol.2312030565
  22. Neumann-Haefelin T, Wittsack HJ, Fink GR, Wenserski F, Li TQ, Seitz RJ, et al. : Diffusion- and perfusion-weighted MRI : influence of severe carotid artery stenosis on the DWI/PWI mismatch in acute stroke. Stroke 31 : 1311-1317, 2000 https://doi.org/10.1161/01.STR.31.6.1311
  23. Nussbaum ES, Janjua TM, Defillo A, Lowary JL, Nussbaum LA : Emergency extracranial-intracranial bypass surgery for acute ischemic stroke. J Neurosurg 112 : 666-673, 2010 https://doi.org/10.3171/2009.5.JNS081556
  24. Reeves MJ, Vaidya RS, Fonarow GC, Liang L, Smith EE, Matulonis R, et al. : Quality of care and outcomes in patients with diabetes hospitalized with ischemic stroke : findings from Get With the Guidelines-Stroke. Stroke 41 : e409-e417, 2010 https://doi.org/10.1161/STROKEAHA.109.572693
  25. Schaefer PW, Hunter GJ, He J, Hamberg LM, Sorensen AG, Schwamm LH, et al. : Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol 23 : 1785-1794, 2002
  26. Schaefer PW, Souza L, Kamalian S, Hirsch JA, Yoo AJ, Kamalian S, et al. : Limited reliability of computed tomographic perfusion acute infarct volume measurements compared with diffusion-weighted imaging in anterior circulation stroke. Stroke 46 : 419-424, 2015 https://doi.org/10.1161/STROKEAHA.114.007117
  27. Seners P, Turc G, Oppenheim C, Baron JC : Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke : a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry 86 : 87-94, 2015 https://doi.org/10.1136/jnnp-2014-308327
  28. Shimoyama T, Shibazaki K, Kimura K, Uemura J, Shiromoto T, Watanabe M, et al. : Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion : association of collateral grade on conventional angiography. Eur J Neurol 20 : 109-116, 2013 https://doi.org/10.1111/j.1468-1331.2012.03801.x
  29. Srinivasan A, Goyal M, Al Azri F, Lum C : State-of-the-art imaging of acute stroke. Radiographics 26 Suppl 1 : S75-S95, 2006 https://doi.org/10.1148/rg.26si065501
  30. Toni D, Fiorelli M, Gentile M, Bastianello S, Sacchetti ML, Argentino C, et al. : Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 52 : 670-675, 1995 https://doi.org/10.1001/archneur.1995.00540310040014
  31. Toyoda K, Fujimoto S, Kamouchi M, Iida M, Okada Y : Acute blood pressure levels and neurological deterioration in different subtypes of ischemic stroke. Stroke 40 : 2585-2588, 2009 https://doi.org/10.1161/STROKEAHA.108.543587
  32. Vaidyula VR, Rao AK, Mozzoli M, Homko C, Cheung P, Boden G : Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes 55 : 202-208, 2006 https://doi.org/10.2337/diabetes.55.01.06.db05-1026
  33. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, et al. : Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITSMOST) : an observational study. Lancet 369 : 275-282, 2007 https://doi.org/10.1016/S0140-6736(07)60149-4
  34. Yamada K, Wu O, Gonzalez RG, Bakker D, Ostergaard L, Copen WA, et al. : Magnetic resonance perfusion-weighted imaging of acute cerebral infarction : effect of the calculation methods and underlying vasculopathy. Stroke 33 : 87-94, 2002 https://doi.org/10.1161/hs0102.101893

Cited by

  1. Optimized CSMRI Algorithm-Based MRI Image Analysis in the Active Rehabilitation Method for Patients with Acute Cerebral Infarction vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/8494784