Effect of Intravenous Thrombolysis on the Time Course of the Apparent Diffusion Coefficient in Acute Middle Cerebral Artery Infarction

2015 ◽  
Vol 25 (6) ◽  
pp. 978-982 ◽  
Author(s):  
Lydia Kretzer ◽  
David Gräßel ◽  
Martin A. Bokemeyer ◽  
Albrecht Günther ◽  
Otto W. Witte ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Time Course ◽  
Intravenous Thrombolysis ◽  
Middle Cerebral Artery Infarction ◽  
Apparent Diffusion

scholarly journals Infarct Volume Before Hemicraniectomy in Large Middle Cerebral Artery Infarcts Poorly Predicts Catastrophic Outcome

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2404-2410
Author(s):  
Barbara Casolla ◽  
Gregory Kuchcinski ◽  
Maéva Kyheng ◽  
Riyad Hanafi ◽  
Jean-Paul Lejeune ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Apparent Diffusion

Background and Purpose: Infarct volumes predict malignant infarcts in patients undergoing decompressive hemicraniectomy (DH) for large middle cerebral artery territory infarcts. The aim of the study was to determine the optimal magnetic resonance imaging infarct volume threshold that predicts a catastrophic outcome at 1 year (modified Rankin Scale score of 5 or death). Methods: We included consecutive patients who underwent DH for large middle cerebral artery infarcts. We analyzed infarct volumes before DH with semi-automated methods on b1000 diffusion-weighted imaging sequences and apparent diffusion coefficient maps. We studied infarct volume thresholds for prediction of catastrophic outcomes, and analyzed sensitivity, specificity, and the area under the curve, a value ≥0.70 indicating an acceptable prediction. Results: Of 173 patients (109 men, 63%; median age 53 years), 42 (24.3%) had catastrophic outcomes. Magnetic resonance imaging b1000 diffusion-weighted imaging and apparent diffusion coefficient infarct volumes were associated to the occurrence of 1-year catastrophic outcome (adjusted odds ratio, 9.17 [95% CI, 2.00–42.04] and odds ratio, 4.18 [95% CI, 1.33–13.19], respectively, per 1 log increase). The optimal volume cutoff of were 211 mL on b1000 diffusion-weighted imaging and 181 mL on apparent diffusion coefficient maps. The 2 methods showed similar sensitivities and specificities and overlapping area under the curve of 0.64 (95% CI, 0.54–0.74). Conclusions: In patients with large middle cerebral artery infarcts, optimal magnetic resonance imaging infarct volume thresholds showed poor accuracy and low specificity to predict 1-year catastrophic outcome, with different b1000 diffusion-weighted imaging and apparent diffusion coefficient thresholds. In the setting of DH, optimal infarct volumes alone should not be used to deny DH, irrespectively of the method used.

scholarly journals The influence of gender on ‘tissue at risk’ in acute stroke: A diffusion-weighted magnetic resonance imaging study in a rat model of focal cerebral ischaemia

2015 ◽  
Vol 36 (2) ◽  
pp. 381-386 ◽  
Author(s):  
Tracey A Baskerville ◽  
I Mhairi Macrae ◽  
William M Holmes ◽  
Christopher McCabe
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Ischaemic Injury ◽  
Diffusion Weighted ◽  
Apparent Diffusion ◽  
Cerebral Artery Occlusion

This is the first study to assess the influence of sex on the evolution of ischaemic injury and penumbra. Permanent middle cerebral artery occlusion was induced in male (n = 9) and female (n = 10) Sprague-Dawley rats. Diffusion-weighted imaging was acquired over 4 h and infarct determined from T2 images at 24 h post-permanent middle cerebral artery occlusion. Penumbra was determined retrospectively from serial apparent diffusion coefficient lesions and T2-defined infarct. Apparent diffusion coefficient lesion volume was significantly smaller in females from 0.5 to 4 h post permanent middle cerebral artery occlusion as was infarct volume. Penumbral volume, and its loss over time, was not significantly different despite the sex difference in acute and final lesion volumes.

scholarly journals Value of computed tomography angiographic collateral status in prediction of malignant middle cerebral artery infarction

2020 ◽  
pp. 4-20
Author(s):  
Sasitorn Petcharunpaisan ◽  
Wannaporn Ngernbumrung ◽  
Sukalaya Lerdlum
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
P Value ◽  
Anterior Circulation ◽  
Independent Predictive Factor ◽  
Middle Cerebral Artery Infarction ◽  
Clinical Criteria

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ≤ 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ≤ 7 was an independent predictor for mMCAi.

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