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Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals

Rajeev Kumar Verma1, Jan Gralla2, Pascal Pedro Klinger-Gratz2

  • 1University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland; Institute of Radiology, Tiefenau Hospital, Spital-Netz Bern, Bern, Switzerland.

Plos One
|September 2, 2015
PubMed
Abstract

Insights

Early MRI findings, specifically diffusion-weighted imaging (DWI) abnormalities in certain brain regions, can predict poor leptomeningeal collateralization in acute ischemic stroke (AIS) patients. This aids in assessing stroke severity and guiding treatment decisions.

Area of Science:

  • Neuroradiology
  • Neuroimaging
  • Stroke Imaging

Background:

  • Assessing leptomeningeal collateralization is crucial for managing acute ischemic stroke (AIS).
  • Current methods may not always be practical for routine clinical evaluation.
  • Early identification of collateral status can significantly impact treatment strategies.

Purpose of the Study:

  • To determine if early ischemic changes on initial MRI can practically estimate leptomeningeal collateralization in AIS.
  • To investigate the correlation between specific MRI findings and angiographically determined collateral status.

Main Methods:

  • Retrospective analysis of MRI (DWI and T2-hyperintensity) in 74 AIS patients.
  • ASPECTS scoring of infarcts and correlation with Higashida collateral grading.
  • Comparison of infarct distribution in well-collateralized (grade 3-4) versus poorly-collateralized (grade 1-2) groups.

Main Results:

  • Diffusion-weighted imaging (DWI)-ASPECTS scores were significantly lower in the poorly-collateralized group (4.51) compared to the well-collateralized group (6.34).
  • Infarctions were significantly less frequent in the insula, M1-M4, and M6 areas in well-collateralized patients.
  • 89% of well-collateralized patients had 0-2 infarcts in these key areas, versus 59.9% of poorly-collateralized patients with 3-6 infarcts.

Conclusions:

  • Poor leptomeningeal collateralization in AIS is associated with more initial infarcts on MRI, particularly in specific ASPECTS areas (insula, M1-M4, M6).
  • DWI abnormalities in these regions serve as a potential surrogate marker for poor leptomeningeal collaterals.
  • This MRI-based estimation can be a valuable tool for routine clinical assessment of collateral status in AIS.

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