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Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals.

Verma RK, Gralla J, Klinger-Gratz PP, Schankath A, Jung S, Mordasini P, Zubler C, Arnold M, Buehlmann M, Lang MF, El-Koussy M, Hsieh K - PLoS ONE (2015)

Bottom Line: Individual ASPECTS areas were compared among the groups.A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088).Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.

View Article: PubMed Central - PubMed

Affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland; Institute of Radiology, Tiefenau Hospital, Spital-Netz Bern, Bern, Switzerland.

ABSTRACT

Objective: The aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS).

Methods: Seventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI) and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS). Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group) and 45 subjects with grade 1 or 2 (poorly-collateralized group). Individual ASPECTS areas were compared among the groups.

Results: Means for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively), and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088). Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.

Conclusion: Patients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation.

No MeSH data available.


Related in: MedlinePlus

Typical pattern of a poorly-collateralized patient.39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.
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pone.0137292.g002: Typical pattern of a poorly-collateralized patient.39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.

Mentions: 39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.


Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals.

Verma RK, Gralla J, Klinger-Gratz PP, Schankath A, Jung S, Mordasini P, Zubler C, Arnold M, Buehlmann M, Lang MF, El-Koussy M, Hsieh K - PLoS ONE (2015)

Typical pattern of a poorly-collateralized patient.39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556517&req=5

pone.0137292.g002: Typical pattern of a poorly-collateralized patient.39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.
Mentions: 39y old female with right-sided M1-occlusion and a poor collateralization grade (Higashida grade 1); DWI (A,D), ADC maps (B,E) and T2w images (C,F). Diffusion restriction (A, B, D and E) is detected in the lentiform nucleus, insula, M1, M2, M4, M5 and M6 according to ASPECTS.

Bottom Line: Individual ASPECTS areas were compared among the groups.A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088).Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.

View Article: PubMed Central - PubMed

Affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland; Institute of Radiology, Tiefenau Hospital, Spital-Netz Bern, Bern, Switzerland.

ABSTRACT

Objective: The aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS).

Methods: Seventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI) and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS). Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group) and 45 subjects with grade 1 or 2 (poorly-collateralized group). Individual ASPECTS areas were compared among the groups.

Results: Means for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively), and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088). Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.

Conclusion: Patients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation.

No MeSH data available.


Related in: MedlinePlus