London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 413 240 Brain imaging Utility of time-intensity curve of perfusion-weighted images to find acute stroke patients in whom endovascular reperfusion therapy can improve their long-term clinical outcome M.N. Nakazaki1, T.M. Mori2, T.I. Iwata3, Y.M. Miyazaki4, Y.T. Takahashi5 Department of Stroke treatment, Shonan Kamakura General Hospital, stroke center,, kamak-ura, JAPAN1, Department of Stroke treatment, Shonan Kamakura General Hospital, stroke center, kamakura, JAPAN2, Department of Stroke treatment, Shonan Kamakura General Hospital, stroke center, kamakura, JAPAN3, Department of Stroke treatment, Shonan Kamakura General Hospital, stroke center, kamakura, JAPAN4, Department of Stroke treatment, Shonan Kamakura General Hos-pital, stroke center, kamakura5 <Background>MR-perfusion-weighted images (PWI) are used in an acute stroke setting, however, it remains unclear how to find patients in whom endovascular reperfusion therapy (ERT) can im-prove their long-term clinical outcome. The purpose of our study was to investigate the relation-ship between time intensity curve (TIC) type of PWI and clinical outcome and to find the TIC type appropriate to ERT.<Methods> Included in our retrospective analysis were acute ischemic stroke patients 1) who admitted to our institution from January 2004 to September 2012 with severe neu-rological deficit (NIHSS≧8), 2) who underwent emergency MRI study including DWI, PWI, and MRA, which suggested internal carotid artery or the middle cerebral artery (MCA) occlusion, and 3) who underwent ERT from three to eight hours from onset. We investigated patient’s baseline characteristics, TIC type, successful recanalization defined as TICI 2B or 3, and 3-month modified Rankin scale (3M-mRS). TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we classified TIC pattern into four types, type 1: TPa>TPc and PSa<PSc/2, type2: TPa>TPc and PSc/2≦PSa<PSc, type 3:TPa＞TPc and PSa≧PSc, and type 4: TPa=TPc. We defined favorable clinical outcome as 3M-mRS of 0 to 2, and assessed the relationship between successful recanalization and favorable clinical outcome in each type of TIC, respectively. <Results> Fifty-five patients were analyzed. There were 10, 30, 15, and 0 patients in TIC type 1, 2, 3, and 4. In TIC type 1,2, and 3 groups, 5 (50%), 19 (63%) and 7 (47%) patients obtained successful recanalization, respectively, and 0, 10 (33%) and 2 (13%) patients achieved fa-vorable clinical outcome, respectively. Among 19 patients who obtained successful recanalization in TIC type 2, 10 (53%) patients had favorable clinical outcome (P<0.01).<Conclusion> Only in pa-tients with TIC type 2, successful recanalization was significantly correlated with a favorable long-term clinical outcome. 241 Brain imaging Dual transcranial direct current stimulation on primaary motor cortex by fMRI K.L. Joa1, J.H. Min2, W.H. Kim3, Y.I. Shin4 Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yang-san- si, SOUTH KOREA1, Department of Rehabilitation Medicine, Pusan National University School of Medicine, , SOUTH KOREA2, Department of Rehabilitation Medicine, Pusan National University School of Medicine, , SOUTH KOREA3, Department of Rehabilitation Medicine, Pusan National University School of Medicine, , SOUTH KOREA4 Background: Transcranial direct current stimulation (tDCS) has been reported as an effective meth-od for manipulating human brain exciatbility through continuous application of a weak direct cur-rent on the scalp. The effect of tDCS varies depending on the polarity of the electrode; anodal polar-ization increases cortical excitability, whereas cathodal polarization decreases it. Also, simultaneous dual tDCS produced an additive effect to facilitate motor performance in the hand. In this study, we observed modulation of motor networks induced by dual tDCS in healthy subjects using functional MRI (fMRI). Methods: Twelve right handed healthy participants (Mean age: 25.6 years, 6 male) underwent two stimulation conditions: 1) Real dual-hemisphere – with anodal tDCS over right primary motor cor-tex (M1) 2) Sham tDCS. Before and after tDCS, fMRI were performed while both finger tapping task were performed in a conventional block design. Participants performed a finger-sequencing task with the non-dominant hand before and after real and sham stimulation outside MR scanner. Results: In the real tDCS session, there was similar activation pattern before and after stimulation during right hand task. When fMRI images between the real and sham tDCS sessions were com-pared, there was no significant interaction in motor network. In the real tDCS session, there was increased activation in right M1 and decreased activation in left M1 and both SMA during left hand task. When fMRI images between the real and sham tDCS sessions were compared, the real tDCS session showed significantly increased activation in the both SMA and left M1 in motor network after applying tDCS. After real tDCS, there was significant improvement in reaction time and move-ment accuracy in finger-sequencing task (p<0.05). Conclusions: Simultaneously dual tDCS over bilateral M1 modulated functional motor networks during motor task. Effective modulation of functional networks by dual tDCS might be a determi-nant to obtain functional improvements in healthy persons by direct or distant effect.
Karger_ESC London_2013
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