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MRI pontine hyperintensity after supratentorial ischemic stroke relates to poor clinical outcome
R Mäntylä1, T Pohjasvaara, R Vataja
1Departments of Radiology, Helsinki University Central Hospital, Helsinki, Finland. ritta.mantyla@helsinki.fi
Background And Purpose:
MRI studies in patients with atherosclerosis often reveal ill-defined hyperintensity in the pons on T2-weighted images. This pontine hyperintensity (PHI) does not fulfill the criteria of a brain infarct, and its clinical relevance is not established. We examined the frequency, as well as the radiological and clinical correlates, of PHI in poststroke patients.
Methods:
Three hundred nineteen patients were studied 3 months after supratentorial ischemic stroke with the use of 1.0-T MRI. Brain infarcts, atrophy, white matter hyperintensities, and PHI were registered. The clinical outcome was assessed 3 and 15 months after the stroke.
Results:
Of the patients, 152 (47.6%) had PHI. The risk factors for stroke did not differ in patients without or with PHI. PHI was related to a higher frequency (P=0.002) and larger volume (P<0.001) of supratentorial brain infarcts, to parietal (P=0.020) and temporal (P=0.002) atrophy, to central atrophy (P< or =0.040), and to white matter hyperintensity grade (P<0.001). Brain infarcts that affected the corpus striatum (putamen, caudate, and pallidum) (P< or =0. 011) or pyramidal tract (P<0.001) were more frequent in patients with PHI. The 3- and 15-month outcomes were worse in patients with PHI (P< or =0.004). The total volume of brain infarcts (OR 1.22), mean atrophy (OR 3.59), and PHI (OR 3.76) were independent correlates of a poor 15-month outcome.
Conclusions:
PHI after supratentorial ischemic stroke deserves attention because it relates to poor clinical outcome.
Insights
Pontine hyperintensity (PHI) on MRI is common after stroke and linked to more severe brain infarcts and worse clinical outcomes. This finding suggests PHI warrants attention in stroke patient assessment.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Atherosclerosis commonly shows ill-defined pontine hyperintensity (PHI) on T2-weighted MRI.
- The clinical significance of PHI, which doesn't meet brain infarct criteria, remains unclear.
Purpose of the Study:
- To investigate the frequency and clinical relevance of PHI in patients post-stroke.
- To identify radiological correlates of PHI in supratentorial ischemic stroke.
Main Methods:
- 1.0-T MRI scans of 319 patients 3 months post-supratentorial ischemic stroke were analyzed.
- Brain infarcts, atrophy, white matter hyperintensities, and PHI were assessed.
- Clinical outcomes were evaluated at 3 and 15 months post-stroke.
Main Results:
- PHI was present in 47.6% of patients.
- PHI correlated with increased frequency and volume of supratentorial brain infarcts, parietal/temporal atrophy, central atrophy, and white matter hyperintensity grade.
- Infarcts in the corpus striatum or pyramidal tract were more common in patients with PHI.
- Poorer 3- and 15-month outcomes were observed in patients with PHI.
- Independent predictors of poor 15-month outcome included total infarct volume, mean atrophy, and PHI.
Conclusions:
- Pontine hyperintensity after supratentorial ischemic stroke is associated with adverse radiological findings.
- PHI is an independent predictor of poor clinical outcome following ischemic stroke.