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Published on: January 23, 2019
Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by
Huijun Zhang1, Xuan Sun2, Qiong Huang1
1Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Diffusion-weighted imaging (DWI) can predict intracranial atherosclerotic stenosis (ICAS) in acute cerebral infarction. Deep infarct cores on DWI suggest ICAS, aiding treatment decisions for middle cerebral artery occlusion.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Differentiating large vessel occlusion causes (intracranial atherosclerotic stenosis vs. embolism) is crucial for acute cerebral infarction treatment.
- Objective evidence for pre-treatment identification of intracranial atherosclerotic stenosis (ICAS) in middle cerebral artery M1 segment occlusion is lacking.
- Deep infarct core location (basal ganglia/semiovoid) is often associated with ICAS-related M1 segment middle cerebral artery occlusion (MCAO).
Purpose of the Study:
- To determine if infarct core location on diffusion-weighted imaging (DWI) can differentiate ICAS from intracranial embolism.
- To assess the utility of DWI in predicting the etiology of M1 segment middle cerebral artery occlusion.
Main Methods:
- Retrospective analysis of 31 acute cerebral infarction patients with M1 segment middle cerebral artery occlusion.
- Patients categorized into ICAS and embolic occlusion groups based on angiography.
- Infarct core location (deep vs. superficial) on DWI was analyzed.
Main Results:
- A deep infarct core on DWI was observed in 93.3% of ICAS patients versus 6.7% of non-ICAS patients (P < 0.001).
- DWI demonstrated 93.3% sensitivity, 87.5% specificity, 87.5% positive predictive value, and 93.3% negative predictive value for ICAS.
- Overall diagnostic accuracy of DWI for ICAS was 88.5%.
Conclusions:
- Diffusion-weighted imaging (DWI) can effectively predict intracranial atherosclerotic disease-related acute MCAO.
- Infarct core location on DWI serves as a valuable imaging biomarker for differentiating ICAS from embolic MCAO.
- This finding can guide treatment strategies for acute cerebral infarction.
Abstract:
Background: The differentiation of large vessel occlusion caused by intracranial atherosclerotic stenosis (ICAS) or intracranial embolism significantly impacts the course of treatment (i.e., intravenous thrombolysis versus mechanical thrombectomy) for acute cerebral infarction. Currently, there is no objective evidence to indicate ICAS-related middle cerebral artery M1 segment occlusion before treatment. In cases of ICAS, it is often observed that the infarct core caused by ICAS-related M1 segment middle cerebral artery occlusion (MCAO) is located in deeper parts of the brain (basal ganglia or semiovoid region). Objective: To evaluate whether the location of the infarct core, identified using diffusion-weighted imaging (DWI), can be used to differentiate ICAS from intracranial embolism. Methods: Thirty-one consecutive patients diagnosed with acute cerebral infarction caused by middle cerebral artery M1 segment occlusion were retrospectively included based on angiographic findings to distinguish ICAS from embolic occlusion. Patients were divided into two groups based on the location of the infarct core on DWI: in the deep part of the brain (basal ganglia or semiovoid region) or more superficially (i.e., cortex). Results: In 16 patients, the infarct core was mainly in the deep part of the brain on DWI [14 of 16 patients in the ICAS group and only 2 in the non-ICAS group (93.3 vs. 6.7%, respectively; P < 0.001)]. The diagnostic sensitivity of DWI for ICAS was 93.3%, with a specificity of 87.5%, a Positive predictive value (PPV) of 87.5%, and an Negative predictive value (NPV) of 93.3%, the accuracy was 88.5%. Conclusion: Intracranial atherosclerotic disease-related acute MCAO can be predicted using DWI.
