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Updated: Oct 9, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Relationship between vascular enhancement, cerebral hemodynamics, and MR angiography in cases of acute stroke
1Department of Neurological Sciences, University of Rome La Sapienza, Italy.
Background And Purpose:
The use of MR angiography and contrast-enhanced T1-weighted MR imaging in cases of acute cerebral ischemia may be helpful in the evaluation of middle cerebral artery (MCA) occlusion and leptomeningeal collaterals, respectively. The aim of our work was to investigate the relationship between MCA occlusion, T1-weighted vascular contrast enhancement, hemodynamic alterations, and tissue damage in cases of acute ischemic stroke.
Methods:
We studied the MCA territory in 15 patients with acute ischemic stroke within 8 hr of symptom onset. The first MR imaging study (<8 hr after onset) comprised diffusion-weighted imaging, MR angiography, perfusion-weighted imaging, and contrast-enhanced T1-weighted MR imaging sequences. Follow-up MR imaging, performed 1 week later, consisted of MR angiography and T2-weighted fluid-attenuated inversion recovery MR imaging.
Results:
Early MR angiography showed MCA stem occlusion in nine of 15 patients. Patients with MCA occlusion had significantly larger areas of abnormality on early diffusion-weighted images, significantly larger areas of altered hemodynamics, larger final lesion volumes, and poorer clinical outcome. Among the nine patients with MCA stem occlusion, vascular enhancement was marked in seven and absent in two who had complete MCA infarcts and poor clinical outcome. Among patients with MCA patency, vascular enhancement was marked in only one, mild in four, and absent in one. Patients with marked vascular enhancement had significantly larger regions of altered hemodynamics and significantly higher asymmetries in both regional cerebral blood volume and mean transit time because of increased values in the affected hemisphere.
Conclusion:
Among patients with stroke with MCA occlusion, marked vascular enhancement and increased blood volume indicate efficient leptomeningeal collaterals and compensatory hemodynamic mechanisms.
Insights
Middle cerebral artery (MCA) occlusion in acute ischemic stroke is linked to larger lesions and poorer outcomes. Marked vascular enhancement suggests efficient collateral circulation and compensatory mechanisms.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke evaluation often involves MR angiography for middle cerebral artery (MCA) occlusion and contrast-enhanced T1-weighted imaging for leptomeningeal collaterals.
- Understanding the interplay between MCA occlusion, hemodynamic changes, and tissue damage is crucial for acute stroke management.
Purpose of the Study:
- To investigate the relationship between MCA occlusion, T1-weighted vascular contrast enhancement, hemodynamic alterations, and tissue damage in acute ischemic stroke patients.
Main Methods:
- 15 patients with acute ischemic stroke within 8 hours of symptom onset were studied.
- Initial MRI included diffusion-weighted imaging, MR angiography, perfusion-weighted imaging, and contrast-enhanced T1-weighted imaging.
- Follow-up MRI at 1 week included MR angiography and T2-weighted FLAIR.
Main Results:
- MCA stem occlusion was detected in 9 of 15 patients via early MR angiography.
- MCA occlusion correlated with larger diffusion-weighted imaging abnormalities, altered hemodynamics, larger final lesion volumes, and poorer clinical outcomes.
- Marked vascular enhancement in MCA occlusion cases indicated efficient leptomeningeal collaterals and compensatory hemodynamic mechanisms.
Conclusions:
- In acute ischemic stroke with MCA occlusion, marked vascular enhancement and increased blood volume signify effective leptomeningeal collateralization.
- These findings highlight the role of compensatory hemodynamic mechanisms in mitigating stroke severity.
