Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the...

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Intraparenchymal hyperattenuations (IPH) are common after endovascular recanalization in stroke patients.
• IPH are presumed to occur in ischemic areas with blood-brain barrier breakdown.
• Limited studies have investigated the interaction between IPH and initial ischemic lesions.

Purpose of the Study:

• To assess the relationship between intraparenchymal hyperattenuations (IPH) and prethrombectomy diffusion-weighted imaging (DWI) lesions.
• To understand the localization patterns of IPH in relation to the ischemic core.
• To evaluate the clinical significance of IPH in stroke patients.

Main Methods:

• Retrospective multicenter study of 27 acute stroke patients.
• Performed diffusion-weighted imaging (DWI) before flat-panel computed tomography (FP-CT) and mechanical thrombectomy.
• Utilized software-based coregistration of DWI and FP-CT for lesion volumetry and overlap analysis.

Main Results:

• Observed two IPH patterns: within the DWI lesion and exceeding the DWI lesion.
• IPH exceeding DWI lesions indicated demarcated infarction at 24 hours.
• IPH predominantly occurred in the basal ganglia and insular cortex, with no major post-IPH hemorrhage.

Conclusions:

• IPH primarily manifest within the initial ischemic core and secondarily in progressed penumbral tissue.
• IPH can represent the minimum final infarct volume.
• Understanding IPH patterns may aid peri-interventional decision-making in stroke management.