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Published on: January 4, 2013
Arterial enhancement in acute cerebral ischemia: clinical and angiographic correlation
D P Mueller1, W T Yuh, D J Fisher
1Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.
Purpose:
To investigate the cause and clinical significance of arterial enhancement (AE) in contrast-enhanced T1-weighted MR examinations after acute cerebral ischemia.
Methods:
Contrast MR examinations and conventional angiograms of 17 patients studied following an acute ischemic event or an internal carotid occlusion were retrospectively reviewed. MR and angiographic studies were performed within 1 day of each other. The presence of AE was correlated with both angiographic findings and patient clinical status.
Results:
AE was not confined to patients with angiographic evidence of complete arterial occlusion. Only 64% of patients demonstrating AE had complete occlusion angiographically. Complete arterial occlusion did not always correlate with AE. In two of nine patients with complete occlusion, no AE was identified. In five of 10 patients with AE, angiographic slow flow was identified. In patients without AE, no angiographic slow flow was identified. In the 64% of patients with AE, significant symptoms were identified. Patients without AE were either asymptomatic or had mild symptoms at the time of the MR study.
Conclusions:
Our data support the hypothesis that arterial slowing is the cause of AE, which appears to be an indicator of decreased brain perfusion. Such MR findings may add important supplemental information to those provided by conventional angiography.
Insights
Arterial enhancement (AE) on MRI after stroke is caused by slow blood flow, indicating reduced brain perfusion. This finding provides crucial clinical information beyond conventional angiography.
Area of Science:
- Neuroradiology
- Cerebrovascular disease
- Medical imaging
Background:
- Acute cerebral ischemia poses significant diagnostic challenges.
- Contrast-enhanced T1-weighted Magnetic Resonance (MR) imaging is a key tool in evaluating stroke.
- Arterial enhancement (AE) is an observed phenomenon in these examinations.
Purpose of the Study:
- To determine the underlying cause of arterial enhancement (AE) after acute cerebral ischemia.
- To elucidate the clinical significance of AE observed in contrast-enhanced T1-weighted MR examinations.
- To correlate AE with angiographic findings and patient clinical status.
Main Methods:
- Retrospective review of contrast-enhanced MR examinations and conventional angiograms in 17 patients post-acute ischemic event or internal carotid occlusion.
- MR and angiographic studies were performed within 24 hours of each other.
- Correlation of AE presence with angiographic results and clinical presentation.
Main Results:
- Arterial enhancement (AE) was observed in 64% of patients with complete arterial occlusion, but not exclusively.
- Complete arterial occlusion did not consistently correlate with AE; some occlusions lacked AE, and some AE cases showed slow flow.
- Patients with AE exhibited significant symptoms, while those without AE were asymptomatic or mildly symptomatic.
Conclusions:
- Arterial slowing is hypothesized as the cause of AE in acute cerebral ischemia.
- AE appears to be a significant indicator of decreased brain perfusion.
- These MR findings offer valuable supplemental information compared to conventional angiography.
