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Published on: September 16, 2017
Perfusion-Weighted MRI Parameters for Prediction of Early Progressive Infarction in Middle Cerebral Artery Occlusion
Hoon Kim1, Yerim Kim2, Young Woo Kim1
1Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Objective:
Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI.
Methods:
We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ≥2 points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI.
Results:
Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI.
Conclusion:
The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.
Insights
Early progressive infarction (EPI) in middle cerebral artery (MCA) occlusion patients is common. A low cerebral blood volume (rCBV) ratio, identified via MRI perfusion imaging, can predict EPI development.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Early progressive infarction (EPI) is a frequent complication in middle cerebral artery (MCA) occlusion, leading to poor functional outcomes.
- Identifying predictors of EPI is crucial for timely intervention and improved patient management.
Purpose of the Study:
- To evaluate magnetic resonance imaging (MRI) perfusion parameters as predictors of EPI in patients with MCA occlusion.
Main Methods:
- Retrospective analysis of patients with acute MCA territory infarction due to MCA occlusion.
- EPI defined as a ≥2 point increase in NIH Stroke Scale within 24 hours.
- Analysis of regional cerebral blood volume (rCBV) ratio and regional time to peak (rTTP) ratio from perfusion MRI.
Main Results:
- 18 of 64 patients (28%) developed EPI, all within 3 days of hospitalization.
- Diabetes mellitus, low rCBV ratio (<0.85), and low rTTP ratio were significantly different between groups.
- Multivariate analysis showed diabetes mellitus (OR 6.13) and low rCBV ratio (OR 6.57) significantly correlated with EPI.
Conclusions:
- EPI occurs in a considerable proportion of acute MCA infarction patients with MCA occlusion.
- The rCBV ratio is a valuable neuroimaging parameter for predicting EPI in this patient population.
