Evaluation of the ischemic penumbra focusing on the venous drainage: the role of susceptibility weighted imaging (SWI) in pediatric ischemic cerebral stroke

Avner Meoded; Andrea Poretti; Jane E Benson; Aylin Tekes; Thierry A G M Huisman

doi:10.1016/j.neurad.2013.04.002

Evaluation of the ischemic penumbra focusing on the venous drainage: the role of susceptibility weighted imaging (SWI) in pediatric ischemic cerebral stroke

J Neuroradiol. 2014 May;41(2):108-16. doi: 10.1016/j.neurad.2013.04.002. Epub 2013 Jul 1.

Authors

Avner Meoded¹, Andrea Poretti¹, Jane E Benson¹, Aylin Tekes¹, Thierry A G M Huisman²

Affiliations

¹ Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Sheikh Zayed Tower, Room 4174, 1800, Orleans Street, Baltimore, MD 21287-0842, USA.
² Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Sheikh Zayed Tower, Room 4174, 1800, Orleans Street, Baltimore, MD 21287-0842, USA. Electronic address: thuisma1@jhmi.edu.

PMID: 23827386
DOI: 10.1016/j.neurad.2013.04.002

Abstract

Background and purpose: Susceptibility weighted imaging (SWI) allows the study of the intracranial venous vasculature based on the paramagnetic susceptibility effects of deoxygenated blood. Prominent hypointense draining veins have been revealed in ischemic brain tissue by SWI. The goal of our study was to evaluate whether a match or mismatch between territorial changes in the venous drainage of ischemic brain tissue, as identified by SWI and diffusion restriction, can show a 'venous ischemic penumbra'.

Materials and methods: Eight children with a confirmed diagnosis of acute pediatric arterial ischemic stroke (PAIS) were included in this preliminary study. All had undergone an acute standard magnetic resonance imaging (MRI) study with diffusion-weighted imaging (DWI) and SWI sequences. SWI scans were semi-quantitatively evaluated for signal intensity and caliber of both the intramedullary and sulcal veins. In addition, SWI abnormalities were compared with DWI images for match/mismatch of signal alterations, and the acute MRI data were compared with follow-up scans.

Results: A total of 17 vascular territories showed infarction. SWI hypointensity in sulcal and intramedullary veins was found in 77% and 94% of the infarcted territories, respectively, while the caliber of the sulcal and intramedullary veins was increased in 64% and 88% of the infarcted areas, respectively. SWI/DWI match was observed in 88% of the vascular territories, whereas mismatch was noted in two; follow-up neuroimaging showed infarct progression into the mismatch areas.

Conclusion: Our study showed that, in children, high-quality SWI studies focused on venous drainage can provide important non-invasive data on critically perfused brain tissue at risk of infarct progression. SWI is therefore a valuable MR tool that can be added to the battery of neuroimaging techniques for acute PAIS.

Keywords: Children; Ischemic penumbra; Ischemic stroke; Magnetic resonance imaging; Susceptibility weighted imaging.

Publication types

Case Reports

MeSH terms

Adolescent
Blood Flow Velocity
Brain Ischemia / complications
Brain Ischemia / pathology*
Brain Ischemia / physiopathology*
Cerebral Veins / pathology*
Cerebral Veins / physiopathology*
Cerebrovascular Circulation
Child
Female
Humans
Infant
Infant, Newborn
Magnetic Resonance Angiography / methods*
Male
Pilot Projects
Reproducibility of Results
Sensitivity and Specificity
Stroke / etiology
Stroke / pathology*
Stroke / physiopathology*