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Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau
1From the Department of Neurology, Hartford Hospital and University of Connecticut School of Medicine, Hartford, Connecticut. pasquale.finelli@hhchealth.org.
AJNR. American Journal of Neuroradiology
|July 2, 2016
Summary
Cancer-associated hypercoagulation is a frequent cause of ischemic infarction in patients with multiple DWI lesions. This condition should be considered when no other embolic source is identified, accounting for 75% of such cases.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Diffusion-weighted imaging (DWI) infarcts in bilateral anterior and posterior circulation often suggest an embolic source.
- Identifying the etiology of such infarcts is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the diagnostic value of DWI lesions in 3 or more cerebral vascular territories for detecting ischemic infarction due to cancer-associated hypercoagulation.
- To determine the prevalence of malignancy-related infarcts in cases without an identifiable embolic source.
Main Methods:
- Retrospective analysis of 4075 brain MR imaging studies.
- Identified 41 studies with DWI lesions in 3+ vascular territories of bilateral anterior and posterior circulation.
- Analyzed etiologies of these DWI lesions.
Main Results:
- Malignancy-related infarctions were the most frequent etiology (22%), followed by hypoxic-ischemic injury (12%).
- Malignancy was the most frequent etiology not suspected clinically or radiographically (P < .001).
- Malignant infarcts exhibited characteristic nonenhancing, peripheral, clustered restricted diffusion lesions.
Conclusions:
- Approximately 20% of ischemic infarcts with DWI lesions in 3+ territories are malignancy-related.
- Cancer-associated hypercoagulation accounts for 75% of infarcts when no embolic source is found.
- Consider cancer-associated hypercoagulation infarction in cases without an apparent cause.
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