Dynamic susceptibility contrast perfusion MRI identifies persistent vessel pathology in acute pontine stroke.
BACKGROUND
In large territorial stroke of the anterior and the posterior circulation, the extent of affected tissue can be characterized by the demonstration of vessel occlusion on MR angiography (MRA), while the extent of hypoperfusion can be shown on dynamic susceptibility contrast perfusion-weighted MRI (PWI). The ability of MRA and conventional MRI sequences to demonstrate branches of the basilar artery (BA) is very limited. This study analyzes the value of the combined use of diffusion-weighted MRI (DWI), MRA and PWI in acute pontine stroke.


METHODS
A series of 24 consecutive patients with acute pontine stroke received an extensive MRI stroke workup including DWI, PWI and MRA.


RESULTS
In 11/24 patients visual analysis of PWI demonstrated persisting hypoperfusion, and in 1/24 patients indication of hyperperfusion was found. Vessel abnormalities were seen in 19/24 patients (15/24 hypoplastic vertebral artery, 9/24 stenosis or occlusion of the BA, 1/20 ectatic BA). Persistent pontine hypoperfusion was more frequently associated with BA pathology (9/11 vs. 1/13, p = 0.001), large-vessel disease (8/11 vs. 1/13; p = 0.001) and a more pronounced clinical deficit (NIHSS score on day 1: 7 vs. 3, p = 0.01).


CONCLUSIONS
In pontine ischemia areas of hypoperfusion can be identified due to the strong contrast induced by ischemia on PWI and can be easily related to DWI lesion size. This is of use particularly as small vessels are frequently missed by MRA and occlusion of the BA can be better characterized with the help of PWI.
Förster
Alex
A
Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim, Germany. a.foerster @ neuro.ma.uni-heidelberg.de
Ottomeyer
Caroline
C
Wolf
Marc E
ME
Kern
Rolf
R
Griebe
Martin
M
Gass
Achim
A
Hennerici
Michael G
MG
Szabo
Kristina
K
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000209:etiology / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology*; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000150:complications / Q000473:pathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D055420:Perfusion Imaging; D011149:Pons / Q000098:blood supply*; D012720:Severity of Illness Index
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D005682:Gadolinium; C072417:gadoterate meglumine