Hyperperfusion and Blood-Brain Barrier Disruption beyond the Diffusion-Restricted Infarct 1 Day after Successful
Matthias A Mutke1,2, Arne Potreck1, Markus A Möhlenbruch1
1From the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany.
AJNR. American Journal of Neuroradiology
|November 22, 2024
Summary
This study shows that advanced MRI techniques can detect subtle changes in brain perfusion and blood-brain barrier integrity after stroke, even outside the main infarct area. These findings are common in stroke patients post-thrombectomy.
Area of Science:
- Neuroimaging
- Cerebrovascular Diseases
- Stroke Imaging
Background:
- Cerebral microcirculatory response patterns in stroke patients with large vessel occlusion remain unclear.
- Understanding blood-brain barrier (BBB) changes and perfusion beyond the infarct core is crucial after recanalization.
Purpose of the Study:
- To investigate cerebral microcirculatory response patterns using combined dynamic contrast-enhanced (DCE) permeability and dynamic susceptibility contrast (DSC) perfusion MRI.
- To detect changes in BBB and perfusion beyond the diffusion-restricted infarct core after successful recanalization in stroke patients.
Main Methods:
- Prospective study of 38 patients within 24 hours of successful mechanical recanalization for acute MCA occlusion.
- Utilized combined DCE-permeability and DSC-perfusion MRI to assess cerebral blood flow (CBF), cerebral blood volume (CBV), and BBB disruption (BBBD) via Ktrans maps.
- Quantitative analysis using ipsilateral to contralateral white matter ratios and logistic regression for clinical outcome.
Main Results:
- Subtle hyperperfusion (elevated CBF/CBV) was observed beyond the DWI lesion in 34-39% of patients.
- Elevated Ktrans values indicating subtle BBBD outside the DWI lesion were seen in 18% of patients.
- No significant relationship was found between these perfusion alterations and early clinical outcome.
Conclusions:
- Combined DCE-permeability and DSC-perfusion MRI are feasible for assessing stroke patients 24 hours post-thrombectomy.
- These advanced imaging techniques reveal frequent subtle hyperperfusion and BBBD beyond the diffusion-restricted infarct core.
- The study highlights the utility of advanced MRI in characterizing microcirculatory changes in the penumbra region after stroke.
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