Case ReportA Mismatch Between the Abnormalities in Diffusion- and Susceptibility-Weighted Magnetic Resonance Imaging May Represent an Acute Ischemic Penumbra with Misery Perfusion
Section snippets
Case Report
A 54-year-old man was injured by a factory machine. A slow-moving round compressor crushed the man at his left neck and at the right parietal of his head. Immediately after, he was safely rescued. However, his colleagues found him to be in a state of confusion, and took him to a local hospital. The head and neck computed tomographic (CT) scans on arrival at the hospital showed no marked abnormality. He had no neurological deficits but the Glasgow Coma Scale was E4V4M6. The mild consciousness
Discussion
Cerebral misery perfusion signifies a critical hypoperfusion that leads to a metabolic compensation state with increased oxygen extraction fraction.5 This compensation state results in remarkably increased deoxyhemoglobin concentration in the venous system in the ischemic tissue. The MRI study in our patient, who suffered blunt cervical trauma that induced an ICA occlusion, showed an acute cerebral ischemic change of DWI-SWI mismatch, to be precise, a discrepancy between a smaller DWI cytotoxic
Conclusion
The area of mismatch between a smaller DWI cytotoxic edema and a larger area with SWI hypo-intense veins in our patient matured into a complete infarction with time. The DWI-SWI mismatch may signify the presence of an ischemic penumbra with misery perfusion, and provide information about viability of the brain tissue at risk of potential infarction.
References (11)
- et al.
Combined diffusion and perfusion MRI with correlation to single-photon emission CT in acute ischemic stroke: ischemic penumbra predicts infarct growth
Stroke
(1999) - et al.
Contribution of susceptibility-weighted imaging to acute stroke assessment
Stroke
(2004) - et al.
Susceptibility weighted imaging in cerebral hypoperfusion–can we predict increased oxygen extraction fraction?
Neuroradiology
(2010) - et al.
Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET
J Neurol Neurosurg Psychiatry
(1996) - et al.
Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia: a case study with 15O positron emission tomography
Stroke
(1981)
Cited by (32)
Increased internal cerebral vein diameter is associated with age
2021, Clinical ImagingCitation Excerpt :A series of subsequent studies demonstrated an association between decreased CBF and asymmetrically prominent cortical or deep medullary veins. The reason was that an imbalance of oxygen supply and demand in the hypoperfused tissue and an increased oxygen extraction fraction caused a relatively increased ratio of deoxyhaemoglobin to oxyhaemoglobin in cortical and medullary veins, which further led to dilated veins on SWI [28–37]. Another mechanism could be increased venous volume due to vasodilatation induced by regional ischaemia [38].
Interactive effect of susceptibility-diffusion mismatch and recanalization status on clinical outcome in large vessel occlusion stroke
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Since deoxyhemoglobin is a paramagnetic substance with high magnetic susceptibility, asymmetric prominent hypointense vessels appear on SWI, which is now called prominent vessel sign (PVS).4,5 Previous studies have reported that PVS on SWI can provide perfusion information comparable to PWI, and SWI–DWI mismatch can indicate ischaemic penumbra.6-8 Although SWI appears to be an alternative to PWI, its application value in recanalization therapy for patients with acute ischemic stroke remains unclear and needs to be investigated.
Utility of high-b-value diffusion-weighted magnetic resonance imaging in evaluating reversible medial longitudinal fasciculus syndrome caused by acute brainstem ischemia
2015, Journal of Stroke and Cerebrovascular DiseasesComparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke
2015, Journal of NeuroradiologyCitation Excerpt :Some imaging techniques used to detect the ischemic penumbra, such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), and perfusion-weighted imaging (PWI), require radionucleotides or contrast agents, which limits their clinical application [5]. Susceptibility-weighted imaging (SWI) is a relatively new high-resolution magnetic resonance imaging (MRI) technique that has been used to detect the penumbra in stroke patients [6–8]. SWI does not require administration of radionucleotides or contrast agents, but uses paramagnetic susceptibility effects to study metabolic changes in hypoperfused brain tissues [9–12].
Prominent cerebral veins on susceptibility-weighted angiography in acute meningoencephalitis
2023, Brain and BehaviorComparing Perfusion Data of CE-MRI, SWI, and CTA with MR Perfusion in Stroke
2023, Current Medical Imaging
Dr Siesjö is Professor Emeritus.
Funding sources: None.