Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Perfusion Deficits in Different Mechanisms of Two Subtypes of Acute Stroke with Diffusion MRI Confirmation

Author(s): Cuiting Zhu, Wei Qin and Wenli Hu*

Volume 20, Issue 1, 2023

Published on: 20 February, 2023

Page: [35 - 42] Pages: 8

DOI: 10.2174/1567202620666221230141102

Price: $65

conference banner
Abstract

Background: Branch atheromatous disease (BAD) and lacunar infract (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke.

Materials and Methods: Five hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Based on diffusion MRI, the patients were assigned to one of two subtypes: BAD and LI. Lesion volumes were measured on NCCT, CTA, CBV, CBF, MTT, and TTP maps by region-of-interest analysis and were confirmed by follow-up MRI.

Results: One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) BAD group and 5 of 18 (27.8%) LI group had perfusion deficits in the supratentorial region. BAD had a higher proportion of abnormal perfusion than LI patients, with a significant difference (P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in BAD patients.

Conclusion: CTP has high specificity in identifying BAD. Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.

« Previous Next »
[1]
Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: Incidence, recurrence, and long-term survival in ischemic stroke subtypes: A population-based study. Stroke 2001; 32(12): 2735-40.
[http://dx.doi.org/10.1161/hs1201.100209] [PMID: 11739965]
[2]
Norrving B. Long-term prognosis after lacunar infarction. Lancet Neurol 2003; 2(4): 238-45.
[http://dx.doi.org/10.1016/S1474-4422(03)00352-1] [PMID: 12849212]
[3]
Caplan LR. Lacunar infarction and small vessel disease: Pathology and pathophysiology. J Stroke 2015; 17(1): 2-6.
[http://dx.doi.org/10.5853/jos.2015.17.1.2] [PMID: 25692102]
[4]
Caplan LR. Intracranial branch atheromatous disease: A neglected, understudied, and underused concept. Neurology 1989; 39(9): 1246-50.
[http://dx.doi.org/10.1212/WNL.39.9.1246] [PMID: 2671793]
[5]
Regenhardt RW, Das AS, Lo EH, Caplan LR. Advances in understanding the pathophysiology of lacunar stroke. JAMA Neurol 2018; 75(10): 1273-81.
[http://dx.doi.org/10.1001/jamaneurol.2018.1073] [PMID: 30167649]
[6]
Huang YC, Lee JD, Pan YT, et al. Perfusion defects and collateral flow patterns in acute small subcortical infarction: A 4D Dynamic MRI Study. Transl Stroke Res 2022; 13(3): 399-409.
[http://dx.doi.org/10.1007/s12975-021-00953-x] [PMID: 34648143]
[7]
Chen Y, Liu Y, Luo C, Lu W, Su B. Analysis of multiple factors involved in acute progressive cerebral infarction and extra- and intracranial arterial lesions. Exp Ther Med 2014; 7(6): 1495-505.
[http://dx.doi.org/10.3892/etm.2014.1624] [PMID: 24926332]
[8]
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[9]
Shi Z, Li J, Zhao M, et al. Baseline cerebral ischemic core quantified by different automatic software and its predictive value for clinical outcome. Front Neurosci 2021; 15: 608799.
[http://dx.doi.org/10.3389/fnins.2021.608799] [PMID: 33911999]
[10]
Yang L, Qin W, Zhang X, Li Y, Gu H, Hu W. Infarct size may distinguish the pathogenesis of lacunar infarction of the middle cerebral artery territory. Med Sci Monit 2016; 22: 211-8.
[http://dx.doi.org/10.12659/MSM.896898] [PMID: 26788612]
[11]
Förster A, Mürle B, Böhme J, et al. Perfusion-weighted imaging and dynamic 4D angiograms for the estimation of collateral blood flow in lacunar infarction. J Cereb Blood Flow Metab 2016; 36(10): 1744-54.
[http://dx.doi.org/10.1177/0271678X15606458] [PMID: 26661161]
[12]
Poppe AY, Coutts SB, Kosior J, Hill MD, O’Reilly CM, Demchuk AM. Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration. Cerebrovasc Dis 2009; 28(2): 151-6.
[http://dx.doi.org/10.1159/000225908] [PMID: 19546542]
[13]
Petrone L, Nannoni S, Del Bene A, Palumbo V, Inzitari D. Branch atheromatous disease: A clinically meaningful, yet unproven concept. Cerebrovasc Dis 2016; 41(1-2): 87-95.
[http://dx.doi.org/10.1159/000442577] [PMID: 26671513]
[14]
Biesbroek JM, Niesten JM, Dankbaar JW, et al. Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: A systematic review and meta-analysis. Cerebrovasc Dis 2013; 35(6): 493-501.
[http://dx.doi.org/10.1159/000350200] [PMID: 23736122]
[15]
Hana T, Iwama J, Yokosako S, et al. Sensitivity of CT perfusion for the diagnosis of cerebral infarction. J Med Invest 2014; 61(1.2): 41-5.
[http://dx.doi.org/10.2152/jmi.61.41] [PMID: 24705747]
[16]
McVerry F, Dani KA, MacDougall NJJ, MacLeod MJ, Wardlaw J, Muir KW. Derivation and evaluation of thresholds for core and tissue at risk of infarction using CT perfusion. J Neuroimaging 2014; 24(6): 562-8.
[http://dx.doi.org/10.1111/jon.12134] [PMID: 25039499]
[17]
Cao W, Yassi N, Sharma G, et al. Diagnosing acute lacunar infarction using CT perfusion. J Clin Neurosci 2016; 29: 70-2.
[http://dx.doi.org/10.1016/j.jocn.2016.01.001] [PMID: 26899357]
[18]
Benson JC, Payabvash S, Mortazavi S, et al. CT perfusion in acute lacunar stroke: Detection capabilities based on infarct location. AJNR Am J Neuroradiol 2016; 37(12): 2239-44.
[http://dx.doi.org/10.3174/ajnr.A4904] [PMID: 27538902]
[19]
Lin K, Do KG, Ong P, et al. Perfusion CT improves diagnostic accuracy for hyperacute ischemic stroke in the 3-hour window: study of 100 patients with diffusion MRI confirmation. Cerebrovasc Dis 2009; 28(1): 72-9.
[http://dx.doi.org/10.1159/000219300] [PMID: 19468218]
[20]
Jiang S, Cui JY, Yan YY, Yang T, Tao WD, Wu B. Association of compromised cerebral perfusion with lenticulostriate artery impairments in the subacute phase of branch atheromatous disease. Ther Adv Neurol Disord 2022; 15: 17562864221109746.
[http://dx.doi.org/10.1177/17562864221109746] [PMID: 35813607]
[21]
Das T, Settecase F, Boulos M, et al. Multimodal CT provides improved performance for lacunar infarct detection. AJNR Am J Neuroradiol 2015; 36(6): 1069-75.
[http://dx.doi.org/10.3174/ajnr.A4255] [PMID: 25721075]
[22]
Ha SH, Chang JY, Lee SH, et al. Mechanism of stroke according to the severity and location of atherosclerotic middle cerebral artery disease. J Stroke Cerebrovasc Dis 2021; 30(2): 105503.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105503] [PMID: 33271485]
[23]
Wardlaw JM, Dennis MS, Warlow CP, Sandercock PA. Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology? Ann Neurol 2001; 50(2): 208-15.
[http://dx.doi.org/10.1002/ana.1082] [PMID: 11506404]
[24]
Jiang S, Wu S, Zhang S, Wu B. Advances in understanding the pathogenesis of lacunar stroke: From pathology and pathophysiology to neuroimaging. Cerebrovasc Dis 2021; 50(5): 588-96.
[http://dx.doi.org/10.1159/000516052] [PMID: 33957622]
[25]
Wardlaw JM, Smith C, Dichgans M. Small vessel disease: Mechanisms and clinical implications. Lancet Neurol 2019; 18(7): 684-96.
[http://dx.doi.org/10.1016/S1474-4422(19)30079-1] [PMID: 31097385]
[26]
Yamada M, Yoshimura S, Kaku Y, et al. Prediction of neurologic deterioration in patients with lacunar infarction in the territory of the lenticulostriate artery using perfusion CT. AJNR Am J Neuroradiol 2004; 25(3): 402-8.
[PMID: 15037462]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy