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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:613-620 (4 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Various Patterns of Perfusion-Weighted MR Imaging and MR Angiographic Findings in Hyperacute Ischemic Stroke

Jae Hyoung Kim^,a, Taemin Shin^a, Ji Hoon Park^a, Sung Hoon Chung^a, Nack-Cheon Choi^a and Byeong Hoon Lim^a

^a From the Gyeongsang Institute for Neuroscience (J.H.K., T.S., S.H.C., N.C.C., B.H.L.) and the Research Institute of Industrial Technology (T.S.), Gyeongsang National University; and the Department of Radiology, Gyeongsang National University Hospital (J.H.K., J.H.P., S.H.C.), Chinju, South Korea.

BACKGROUND AND PURPOSE: Various clinical subtypes of patients presenting with sudden-onset ischemic stroke have been recognized, but classification of those types is not simple. We identified various patterns of perfusion-weighted MR imaging and MR angiographic findings in hyperacute ischemic stroke with relation to clinical outcomes.

METHODS: Twelve patients with symptoms of acute ischemic stroke due to middle cerebral artery occlusion underwent perfusion-weighted MR imaging and MR angiography within 6 hours after the onset of symptoms. Perfusion-weighted imaging was performed with a conventional dynamic contrast-enhanced T2*-weighted sequence, and cerebral blood volume (CBV) maps were then created. CBV maps and MR angiographic findings were compared with ^99mTc-HMPAO brain SPECT scans, short-term outcomes, and follow-up imaging findings.

RESULTS: The combined CBV and MR angiographic findings were classified into three patterns: arterial occlusion and decreased CBV (n = 8), arterial occlusion and increased CBV (n = 2), and no arterial occlusion and normal CBV (n = 2). These three patterns were strongly related to SPECT findings, short-term outcomes, and follow-up imaging findings. Perfusion on SPECT decreased markedly in the affected regions in all patients with the first pattern, decreased slightly in the second pattern, and was normal in the third pattern. Symptoms were not significantly changed at 24 hours after onset in any of the patients with the first pattern, but resolved completely in all patients with the latter two patterns. Follow-up imaging showed large infarctions in all patients with the first pattern. Initially, no infarction was seen in the second pattern, but watershed infarction developed later in one of these patients.

CONCLUSION: Hyperacute ischemic stroke may be differentiated into three imaging patterns with different clinical outcomes. The combined use of perfusion-weighted MR imaging and MR angiography may play a substantial role in guiding the choice of treatment of this disease.

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