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Published on: September 25, 2019
Perfusion-weighted MRI as a predictor of clinical outcomes following medullary infarctions
Suk Jae Kim1, Sookyung Ryoo, Oh Young Bang
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Background:
Perfusion-weighted imaging (PWI) is rarely used to evaluate cases of posterior circulation infarctions. We evaluated clinical outcomes, diffusion-weighted imaging (DWI) patterns and angiographic findings in patients experiencing medullary infarctions according to PWI results.
Methods:
Data from consecutive patients with acute ischemic lesions primarily involving the medulla were analyzed. All patients underwent MRI including DWI, PWI and MR angiography. The patients were grouped according to the presence or absence of a perfusion delay in the medulla and/or inferior cerebellum.
Results:
Among 35 patients, all but 1 had a PWI of interpretable quality. Of these 34 patients, 18 had a normal perfusion status, while 16 had perfusion defects in the medulla and/or inferior cerebellum. The abnormal PWI group had poor clinical outcomes at 7 days and 1 month after the onset of symptoms. There was no difference in DWI patterns between these 2 groups. The angiographic findings demonstrated that a stenosis of >or=50% or an occlusion of the ipsilesional vertebral artery was frequently observed in the abnormal PWI group (p = 0.001). Multivariate analysis revealed that abnormal PWI and DWI patterns were independently associated with poor early and late outcomes following medullary infarctions.
Conclusions:
PWI may be a feasible modality for assessing the perfusion status of the posterior circulation and predicting clinical outcomes following medullary infarctions.
Insights
Perfusion-weighted imaging (PWI) can assess posterior circulation and predict outcomes in medullary infarction patients. Abnormal PWI, along with diffusion-weighted imaging (DWI) patterns, indicates poor clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Perfusion-weighted imaging (PWI) is underutilized for posterior circulation infarctions.
- Medullary infarctions require evaluation of clinical outcomes, diffusion-weighted imaging (DWI), and angiographic findings.
Purpose of the Study:
- To evaluate clinical outcomes, DWI patterns, and angiographic findings in medullary infarction patients based on PWI results.
- To determine the feasibility of PWI in assessing posterior circulation perfusion and predicting outcomes.
Main Methods:
- Analysis of consecutive patients with acute medullary ischemic lesions.
- MRI including DWI, PWI, and MR angiography was performed.
- Patients were grouped by the presence or absence of medullary/cerebellar perfusion delay on PWI.
Main Results:
- 16 out of 34 patients showed perfusion defects on PWI, correlating with poor clinical outcomes at 7 days and 1 month.
- No significant difference in DWI patterns was observed between groups.
- High-grade stenosis or occlusion of the ipsilesional vertebral artery was frequent in the abnormal PWI group.
- Abnormal PWI and DWI were independent predictors of poor outcomes.
Conclusions:
- PWI is a feasible tool for evaluating posterior circulation perfusion in medullary infarctions.
- PWI can predict clinical outcomes in patients with medullary infarctions.
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