Temporal changes in blood-brain barrier permeability and cerebral perfusion in lacunar/subcortical ischemic stroke.
BACKGROUND
Cerebral microvascular abnormality is frequently associated with lacunar and subcortical ischemic lesions. We performed acute and follow-up CT perfusion scans over the first 3 months after ischemic stroke to investigate disturbances of the blood-brain barrier (BBB) and cerebral perfusion in patients with lacunar/subcortical lesions compared to those with cortical lesions alone.


METHODS
Thirty-one patients with lacunar/subcortical infarct (n = 14) or with cortical large vessel infarct (n = 17) were recruited and underwent a CT perfusion study at admission, 24 h, 7 days and 3 months after stroke using a two-phase imaging protocol. Functional maps of BBB permeability surface area product (BBB-PS), cerebral blood flow (CBF) and blood volume (CBV) at follow-up were co-registered with those at admission, and the measurements in non-infarcted ipsilateral basal ganglia and thalamus were compared within each group and between the two groups.


RESULTS
For the lacunar/subcortical group, BBB-PS within non-infarcted ipsilateral basal ganglia and thalamus peaked at day 7 compared to all other time points, and was significantly higher than the cortical group at day 7 and month 3. The CBF and CBV in the same region were significantly lower at admission and transient hyperemia was seen at day 7 in the lacunar/subcortical group.


CONCLUSIONS
Disturbed BBB-PS and compromised cerebral perfusion over the first 3 months post stroke were shown in the non-infarcted basal ganglia and thalamus of lacunar/subcortical stroke using CT perfusion. Future studies are required to elucidate the relationship of post-stroke BBB disturbances to chronic cognitive impairment.
Imaging Program, Lawson Health Research Institute, London, ON, Canada. jyang@robarts.ca.|Imaging Research Lab, Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A 5B7, Canada. jyang@robarts.ca.
Jun
J
Yang
Radiology Department and Calgary Stroke Program, University of Calgary, Calgary, AB, Canada. cdesterr@gmail.com.
Christopher
C
d'Esterre
Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy. s.ceruti@ospfe.it.
Stefano
S
Ceruti
Section of Neurology, Department of Medical and Surgical Sciences of the Communication and Behaviour, University of Ferrara, Ferrara, Italy. gloriaroversi@libero.it.
Gloria
G
Roversi
Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy. andreasaletti@libero.it.
Andrea
A
Saletti
Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy. henryfai@tin.it.
Enrico
E
Fainardi
Imaging Program, Lawson Health Research Institute, London, ON, Canada. tlee@robarts.ca.|Imaging Research Lab, Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A 5B7, Canada. tlee@robarts.ca.|Radiology Department and Calgary Stroke Program, University of Calgary, Calgary, AB, Canada. tlee@robarts.ca.
Ting Yim
TY
Lee
D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000098:blood supply* / Q000378:metabolism; D001812:Blood-Brain Barrier / Q000378:metabolism*; D002199:Capillary Permeability; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D010539:Permeability; D011446:Prospective Studies; D020521:Stroke / Q000378:metabolism; D059409:Stroke, Lacunar / Q000378:metabolism*; D013788:Thalamus / Q000098:blood supply* / Q000378:metabolism; D013997:Time Factors; D014057:Tomography, X-Ray Computed