London, United Kingdom 2013 18 Brain imaging B 17:50 - 18:00 Bright and Dark Vessels of Stroke Imaging: Different Sides of the Same Coin? E.M. Arsava1, A. Vural2, R. Gocmen3, K.K. Oguz4, M.A. Topcuoglu5 Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, TUR-KEY1, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, TURKEY2, Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, TURKEY3, Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, TURKEY4, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, TURKEY5 Background: Two imaging features on magnetic resonance imaging, hyperintense vessels on fluid attenuated inversion recovery images (FLAIR-HyperV) and hypointense vessels on T2* or susceptibility weighted images (SWI-HypoV) are accepted as markers of impaired tissue perfu-sion and increased risk for infarct expansion. FLAIR-HyperV are considered to represent lep-tomeningeal collaterals in the vicinity of ischemic territory, while SWI-HypoV are believed to reflect vessels, probably veins, with increased concentration of deoxyhemoglobin. In this study, our aim was to identify the correlation between FLAIR-HyperV and SWI-HypoV, and to deter-mine whether these imaging features provide separate prognostic information in patients with ischemic stroke. Methods: We retrospectively identified ischemic stroke patients with proximal middle cerebral artery occlusion who underwent both SWI and FLAIR imaging within 24 hours of symptom onset. The number of FLAIR-HyperV and SWI-HypoV were determined in each patient, com-pared with each other and NIHSS scores at admission and at 24 hours. Results: The study population comprised of 43 patients with a median (interquartile range) age of 71 (60-78) years and admission NIHSS score of 16 (10-20). There was a moderate, but sig-nificant correlation between number of FLAIR-HyperV and SWI-HypoV (r=0.62, p<0.01). The number of FLAIR-HyperV (p=0.05) and SWI-HypoV (p=0.02) were related to change in NI-HSS scores within 24 hours. All patients (n=4) with an increase in NIHSS score >4 at 24 hours had prominent findings in both of these imaging features. Conclusion: Our findings show a significant relationship between FLAIR-HyperV and SWI-HypoV. The presence of both findings in the same patient is associated with unfavorable clinical prognosis. However, their correlation is only modest, suggesting that each reflects dif-ferent, but interrelated aspects of cerebrovascular hemodynamics during cerebral ischemia. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 71 17 Brain imaging B 17:40 - 17:50 Reduction of T1 contrast in a model of pure vascular cognitive impairment F. De Guio1, S. Reyes2, M. Duering3, L. Pirpamer4, H. Chabriat5, E. Jouvent6 Univ Paris Diderot, UMR 740 Inserm, Paris, FRANCE1,Univ Paris Diderot, UMR 740 In-serm, Paris, FRANCE2, Institute for Stroke and Dementia Research, Munich, GERMANY3, Medical University of Graz, Graz, AUSTRIA4, Univ Paris Diderot, UMR 740 Inserm, Lari-boisière Hosp, Department of Neurology, Paris, FRANCE5, Univ Paris Diderot, UMR 740 In-serm, Lariboisière Hosp, Department of Neurology, Paris, FRANCE6 Background Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is the most common heritable cause of stroke and vascular dementia in adults. The contrast between gray matter (GM) and normal appearing white matter (NAWM) on conven-tional T1-weighted Magnetic Resonance Imaging (MRI) has never been investigated in small vessel diseases. The purpose of this work was to evaluate the contrast between GM and NAWM on T1-weighted images in CADASIL patients compared to healthy subjects. Methods Contrast between GM and NAWM was assessed using 3D-T1 high-resolution images acquired with a 3T Tim-Trio MRI scanner in 23 patients with CADASIL at the initial stage of the disease (MMSE>24 and modified Rankin’s scale≤1, mean age 53.5±11.1 years) and 30 age and sex-matched controls. Results T1 contrast between GM and NAWM was significantly reduced in patients compared to age-and- sex matched controls, which persisted after adjustment for age and sex (patients: 1.35±0.08 vs controls: 1.43±0.04, p<10-5). This reduction was mainly driven by a signal decrease in NAWM. Contrast loss was strongly related to the volume of white matter hyperintensities but not to the volume of lacunar lesions or number of microhemorrhages. In patients, we also ob-served a marginal linear relationship between MMSE and contrast between GM and NAWM after adjustment for age and gender (estimate: 9.6, s.e: 4.4, p-value: 0.04). Conclusion Conventional 3D-T1 imaging shows significant loss of contrast between GM and NAWM in CADASIL. This probably reflects tissue changes in NAWM outside signal abnormalities on T2 or FLAIR sequences. These contrast alterations should be taken into account for image inter-pretation and post-processing.
Karger_ESC London_2013
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