Published online before print March 24, 2004, 10.1148/radiol.2312030565
(Radiology 2004;231:517.)
A more recent version of this article appeared on May 1, 2004
Acute Ischemic Stroke: Predictive Value of 2D Phase-Contrast MR Angiography—Serial Study with Combined Diffusion and Perfusion MR Imaging1
Yawu Liu, PhD,
Jari O. Karonen, MD, PhD,
Ritva L. Vanninen, MD, PhD,
Juho Nuutinen, MD,
Anna Koskela, MD,
Seppo Soimakallio, MD, PhD and
Hannu J. Aronen, MD, PhD
1 From the Depts of Clinical Radiology (Y.L., J.O.K., R.L.V., A.K., S.S., H.J.A.) and Neurology (J.N.), Kuopio Univ Hosp, PO Box 1777, FIN-70211 Kuopio, Finland; Dept of Radiology, Mikkeli Central Hosp, Finland (J.O.K.); and Functional Brain Imaging Unit, Helsinki Brain Research Ctr, Finland (H.J.A.). From the 2002 RSNA scientific assembly. Received Apr 10, 2003; revision requested Jun 27; revision received Aug 7; accepted Oct 1. Supported by Kuopio University Hospital (EVO funding 307/97, 21/98, and 5063504), Radiological Society of Finland, Academy of Finland, Sigrid Juselius Foundation, Instrumentarium Science Foundation, Aarne Koskelo Foundation, and Paavo Nurmi Foundation. Address correspondence to Y.L. (e-mail: yawu.liu@kuh.fi).
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Figure 1. Images in a 53-year-old woman with right hemiparesis and aphasia. Transverse maps of rCBV (A), rCBF (B), and MTT (C) obtained 4.5 hours after onset of symptoms show a hypoperfused area (arrows in A) in the left frontal lobe. D, Two-dimensional phase-contrast MR angiogram (group 3) (115/9, 12° flip angle, one signal acquired, 45-cm/sec velocity encoding) does not depict occlusion in ICA (arrowhead) or M1 (arrow). There is no significant mismatch between the lesion on the transverse diffusion-weighted trace image (E) and initial perfusion maps. F, Follow-up transverse T2-weighted image (3,250/90, one signal acquired) obtained 1 week after onset of symptoms shows no significantly larger infarct growth or hemorrhagic transformation.
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Figure 2. Images in a 68-year-old man with left hemiparesis. Transverse maps of rCBV (A), rCBF (B), and MTT (C) obtained 11.5 hours after onset of symptoms show an extensive hypoperfused area (arrows in A). D, Initial 2D phase-contrast MR angiogram (115/9, 12° flip angle, one signal acquired, 45-cm/sec velocity encoding) shows occlusion of right ICA with collateral M1 flow (arrow) (group 2). E, Initial transverse diffusion-weighted trace image shows hyperintense lesion in right temporal and parietal lobes. F, Transverse T2-weighted image (3,250/90, one signal acquired) obtained 1 week after onset of symptoms shows no significantly larger infarct growth, although there is extensive mismatch between the lesion on diffusion-weighted trace image and maps of rCBF and MTT.
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Figure 3. Images in a 73-year-old woman with left hemiparesis. Initial transverse maps of rCBV (A), rCBF (B), and MTT (C) and 2D phase-contrast MR angiogram (D) (115/9, 12° flip angle, one signal acquired, 45-cm/sec velocity encoding) and transverse trace diffusion- (E) and T2-weighted (F) (3,250/90, one signal acquired) images obtained 6.25 hours after onset of symptoms. D shows right ICA occlusion without collateral M1 flow (group 1). Significant rCBF-diffusion and MTT-diffusion mismatches are detected. G, Follow-up 2D phase-contrast MR angiogram obtained on 8th day after stroke shows no recanalization or collateral M1 flow. Transverse trace diffusion- (H) and T2-weighted (I) images obtained 1 week after stroke demonstrate substantial infarct growth in the right basal ganglia and frontal and temporal lobes (arrows).
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Figure 4. Images in a 71-year-old woman with right hemiparesis and aphasia. Initial transverse maps of rCBV (A), rCBF (B), and MTT (C) and 2D phase-contrast MR angiogram (D) (115/9, 12° flip angle, one signal acquired, 45-cm/sec velocity encoding) and transverse trace diffusion- (E) and T2-weighted (F) (3,250/90, one signal acquired) images obtained 6.75 hours after symptom onset. D shows occlusion of the left ICA without collateral M1 flow (group 1). Significant rCBF-diffusion and MTT-diffusion mismatches are detected. G, Two-dimensional phase-contrast MR angiogram obtained 2 days after stroke demonstrates recanalization of the ICA (arrowhead) and M1 (arrow). Transverse trace diffusion- (H) and T2-weighted (I) images demonstrate hemorrhagic transformation in the left basal ganglia (arrow in H) and a substantial infarct growth in the left temporoparietal junction. J, No significant change is seen on MR angiogram obtained on day 8 compared with that in G. Infarction and hemorrhagic transformation (arrows in K) are more extensive on transverse trace diffusion- (K) and T2-weighted (L) images obtained on day 8 than on day 2.
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Figure 5. Images in a 63-year-old woman with right hemiparesis and aphasia. Initial transverse maps of rCBV (A), rCBF (B), and MTT (C) and 2D phase-contrast MR angiogram (D) (115/9, 12° flip angle, one signal acquired, 45-cm/sec velocity encoding) and transverse trace diffusion- (E) and T2-weighted (F) (3,250/90, one signal acquired) images obtained 6.5 hours after onset of symptoms. D shows occlusion of M1 (group 1). Large infarction and significant perfusion-diffusion mismatches are detected. G, MR angiogram obtained on day 2 shows only a partial flow signal (arrow) in the M1. Transverse trace diffusion- (H) and T2-weighted (I) images obtained on day 2 show that infarction extends into the initial hypoperfused area in the left basal ganglia and frontal, temporal, and parietal lobes. J, MR angiogram obtained 1 week after stroke demonstrates M1 flow. Transverse trace diffusion- (K) and T2-weighted (L) images demonstrate a small area of hemorrhagic transformation (arrows).
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Copyright © 2004 by the Radiological Society of North America.
