title: Perfusion-weighted imaging and dynamic 4D angiograms for the estimation of collateral blood flow in lacunar infarction.
abstract: Although lacunar infarction accounts for approximately 25% of ischemic strokes, collateral blood flow through anastomoses is not well evaluated in lacunar infarction. In 111 lacunar infarction patients, we analyzed diffusion-weighted images, perfusion-weighted images, and blood flow on dynamic four-dimensional angiograms generated by use of Signal Processing In NMR-Software. Blood flow was classified as absent (type 1), from periphery to center (type 2), from center to periphery (type 3), and combination of type 2 and 3 (type 4). On diffusion-weighted images, lacunar infarction was found in the basal ganglia (11.7%), internal capsule (24.3%), corona radiata (30.6%), thalamus (24.3%), and brainstem (9.0%). In 58 (52.2%) patients, perfusion-weighted image showed a circumscribed hypoperfusion, in one (0.9%) a circumscribed hyperperfusion, whereas the remainder was normal. In 36 (62.1%) patients, a larger perfusion deficit (>7 mm) was observed. In these, blood flow was classified type 1 in four (11.1%), 2 in 17 (47.2%), 3 in 9 (25.0%), and 4 in six (16.7%) patients. Patients with lacunar infarction in the posterior circulation more often demonstrated blood flow type 2 and less often type 3 (p = 0.01). Detailed examination and graduation of blood flow in lacunar infarction by use of dynamic four-dimensional angiograms is feasible and may serve for a better characterization of this stroke subtype.
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany Alex.Foerster@umm.de.
authors.forename: Alex
authors.initials: A
authors.lastname: Förster
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Mürle
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Böhme
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Mansour
authors.initials: M
authors.lastname: Al-Zghloul
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Kerl
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Wenz
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Groden
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002196:Capillaries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059409:Stroke, Lacunar / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Anastomoses; collateral blood flow; lacunar; stroke