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Chapter 20 - Susceptibility imaging and stroke

from Section 2 - Cerebrovascular disease

Published online by Cambridge University Press:  05 March 2013

Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Basic principles of susceptibility contrast

Magnetic resonance sequences that take advantage of susceptibility effects to demonstrate pathology are powerful and sensitive aids for diagnostic imaging. An important distinction should be highlighted at this point. Although the term susceptibility-weighted imaging (SWI) has been used in the past to refer to T2*-weighted gradient recall echo (GRE) techniques, the more recent convention is to reserve this term for a distinct new sequence utilizing both magnitude and phase information. The bulk of the stroke-related research discussed in this chapter relates to conventional T2*-weighted GRE sequences; susceptibility sequences and SWI are discussed in Ch. 10. In particular, one of the key applications of susceptibility sequences is the identification of hemorrhage and blood products.

The evolution of blood breakdown products undergoes the orderly transition through oxyhemoglobin, deoxyhemoglobin, intracellular methemoglobin, extracellular methemoglobin, and ultimately hemosiderin.[1] The MRI appearance of hemorrhage is determined by the magnetic properties and paramagnetic effects of the hemoglobin breakdown products at different stages of iron oxidation. Deoxyhemoglobin, intracellular methemoglobin, and hemosiderin have many unpaired electrons and these are the paramagnetic breakdown products of hemoglobin.[2–4]

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
, pp. 273 - 288
Publisher: Cambridge University Press
Print publication year: 2009

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References

Kidwell, CS, Wintermark, M.Imaging of intracranial haemorrhage. Lancet Neurol 2008; 7: 256–267.CrossRefGoogle ScholarPubMed
Patel, MR, Edelman, RR, Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 1996; 27: 2321–2324.CrossRefGoogle ScholarPubMed
Linfante, I, Linas, RH, Caplan, LR, Warach, S. MRI features of intracerebral hemorrhage within 2 hours from symptom onset. Stroke 1999; 30: 2236–2267.CrossRefGoogle ScholarPubMed
Schellinger, PD, Jansen, O, Fiebach, JB, et al. A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 1999; 30: 765–768.CrossRefGoogle ScholarPubMed
Edelman, RR, Johnson, K, Buxton, R, et al. MR of hemorrhage: a new approach. AJNR Am J Neuroradiology 1986; 7: 751–756.Google ScholarPubMed
Bradley, WGMR appearance of hemorrhage in the brain. Radiology 1993; 189; 15–26.CrossRefGoogle Scholar
Qureshi, AI, Tuhrim, S, Broderick, JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med 2001; 344: 1450–1460.CrossRefGoogle ScholarPubMed
Kakuda, W, Thijs, VN, Lansberg, MG, for the DEFUSE Investigators. Clinical importance of microbleeds in patients receiving IV thrombolysis. Neurology 2005; 65: 1175–1178.CrossRefGoogle ScholarPubMed
Greenberg, SM, Finklestein, SP, Schaefer, PW. Petechial hemorrhages accompanying lobar hemorrhage: detection by gradient-echo MRI. Neurology 1996; 46: 1751–1754.CrossRefGoogle ScholarPubMed
Gaviani, P, Mullins, ME, Braga, TA, et al. Improved detection of metastatic melanoma by T2*-weighted imaging. AJNR Am J Neuroradiol 2006; 27: 605–608.Google ScholarPubMed
Fiebach, JB, Schellinger, PD, Jansen, O, et al. CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke 2002; 33: 2206–2210.CrossRefGoogle Scholar
Chalela, JA, Kidwell, CS, Nentwich, LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007; 369: 293–298.CrossRefGoogle ScholarPubMed
Hermier, M, Nighoghossian, N. Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke 2004; 35: 1989–1994.CrossRefGoogle ScholarPubMed
Lyden, PD, Zivin, JA.Hemorrhagic transformation after cerebral ischemia: mechanisms and incidence. Cerebrovasc Brain Metab Rev 1993; 5: 1–16.Google ScholarPubMed
Toni, D, Fiorelli, M, Bastianello, S, et al. Hemorrhagic transformation of brain infarct: predictability in the first 5 hours from stroke onset and influence on clinical outcome. Neurology 1996; 46: 341–345.CrossRefGoogle ScholarPubMed
Paciaroni, M, Agnelli, G, Corea, F, et al. Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study. Stroke 2008; 39: 2249–2256.CrossRefGoogle ScholarPubMed
Lin, DD, Filippi, CG, Steever, AB, Zimmerman, RD. Detection of intracranial hemorrhage: comparison between gradient-echo images and B(0) images obtained from diffusion-weighted echo-planar sequences. AJNR Am J Neuroradiol 2001; 22: 1275–1281.Google Scholar
Hjort, N, Butcher, K, Davis, SM, for the UCLA Thrombolysis Investigators. Magnetic resonance imaging criteria for thrombolysis in acute cerebral infarct. Stroke 2005; 36: 388–397.CrossRefGoogle ScholarPubMed
Davis, SM, Donnan, GA, Butcher, KS, Parsons, M. Selection of thrombolytic therapy beyond 3 h using magnetic resonance imaging. Curr Opin Neurol 2005; 18: 47–52.CrossRefGoogle ScholarPubMed
Schellinger, PD, Jansen, O, Fiebach, JB, et al. Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia. AJNR Am J Neuroradiol 2000; 21: 1184–1189.Google ScholarPubMed
Kidwell, CS, Saver, JL, Villablanca, JP, et al. Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke 2002; 33: 95–98.CrossRefGoogle Scholar
Schellinger, PD, Fiebach, JB, Hacke, W. Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status. Stroke 2003; 34: 575–583.CrossRefGoogle ScholarPubMed
Kidwell, CS, Chalela, JA, Saver, JL, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004; 292: 1823–1830.CrossRefGoogle ScholarPubMed
Hacke, W, Donnan, G, Fieschi, C, for the ATLANTIS Trials Investigators, the ECASS Trials Investigators, and the NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363: 768–774.Google Scholar
Reeves, MJ, Arora, S, Broderick, JP, for the Paul Coverdell Prototype Registries Writing Group. Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke 2005; 36: 1232–1240.Google ScholarPubMed
Thomalla, G, Schwark, C, Sobesky, J, for the MRI in Acute Stroke Study Group of the German Competence Network Stroke. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS rtPA trials. Stroke 2006; 37: 852–858.CrossRefGoogle Scholar
Thomalla, G, Sobesky, J, Köhrmann, M, et al. Two tales: hemorrhagic transformation but not parenchymal hemorrhage after thrombolysis is related to severity and duration of ischemia: MRI study of acute stroke patients treated with intravenous tissue plasminogen activator within 6 hours. Stroke 2007; 38: 313–318.CrossRefGoogle Scholar
Schellinger, PD, Thomalla, G, Fiehler, J, et al. MRI-based and CT-based thrombolytic therapy in acute stroke within and beyond established time windows: an analysis of 1210 patients. Stroke 2007; 38: 2640–2645.CrossRefGoogle ScholarPubMed
Köhrmann, M, Jüttler, E, Fiebach, JB, et al. MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study. Lancet Neurol 2006; 5: 661–667.CrossRefGoogle ScholarPubMed
Ringleb, PA, Schwark, Ch, Köhrmann, M, et al. Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome. J Neurol Neurosurg Psychiatry 2007; 78: 690–693.CrossRefGoogle Scholar
Arnould, MC, Grandin, CB, Peeters, A, Cosnard, G, Duprez, TP. Comparison of CT and three MR sequences for detecting and categorizing early (48 hours) hemorrhagic transformation in hyperacute ischemic stroke. AJNR Am J Neuroradiol 2004; 25: 939–944.Google ScholarPubMed
Roob, G, Schmidt, R, Kapeller, P, et al. MRI evidence of past cerebral microbleeds in a healthy elderly population. Neurology 1999; 52: 991–994.CrossRefGoogle Scholar
Kwa, VI, Franke, CL, Verbeeten, B, Stam, J.Silent intracerebral microhemorrhages in patients with ischemic stroke. Amsterdam Vascular Medicine Group. Ann Neurol 1998; 44: 372–377.CrossRefGoogle ScholarPubMed
Fazekas, F, Kleinert, R, Roob, G, et al. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol 1999; 20: 637–642.Google ScholarPubMed
Nighoghossian, N, Hermier, M, Adeleine, P, et al. Old microbleeds are a potential risk factor for cerebral bleeding after ischemic stroke: a gradient-echo T2*-weighted brain MRI study. Stroke 2002; 33: 735–742.CrossRefGoogle ScholarPubMed
Kim, HS, Lee, DH, Ryu, CW, et al. Multiple cerebral microbleeds in hyperacute ischemic stroke: impact on prevalence and severity of early hemorrhagic transformation after thrombolytic treatment. Am J Roentgenol 2006; 186: 1443–1449.CrossRefGoogle ScholarPubMed
Fiehler, J, Albers, GW, Boulanger, JM, for the MR STROKE Group. Bleeding risk analysis in stroke imaging before thrombolysis (BRASIL): pooled analysis of T2*-weighted magnetic resonance imaging data from 570 patients. Stroke 2007; 38: 2738–2744.CrossRefGoogle ScholarPubMed
Rovira, A, Orellana, P, Alvarez-Sabin, J, et al. Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology 2004; 232: 466–473.CrossRefGoogle ScholarPubMed
Flacke, S, Urbach, H, Keller, E, Träber, F, Hartmann, A, Textor, J, Gieseke, J, Block, W, Folkers, PJ, Schild, HH.Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology 2000 May; 215: 476–82.CrossRefGoogle ScholarPubMed
Cho, KH, Kim, JS, Kwon, SU, Cho, AH, Kang, DW. Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke. 2005 Nov; 36: 2379–83.CrossRefGoogle ScholarPubMed
Schellinger, PD, Chalela, JA, Kang, DW, Latour, LL, Warach, S. Diagnostic and prognostic value of early MR imaging vessel signs in hyperacute stroke patients imaged <3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 2005; 26: 618–624.Google Scholar
Kim, HS, Lee, DH, Choi, CG, Kim, SJ, Suh, DC. Progression of middle cerebral artery susceptibility sign on T2*-weighted images: its effect on recanalization and clinical outcome after thrombolysis. Am. J. Roentgenol, December 1, 2006; 187: W650–W657.CrossRefGoogle ScholarPubMed
Ayanzen, RH, Bird, CR, Keller, PJ, et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol 2000; 21: 74–78.Google ScholarPubMed
Hinman, JM, Provenzale, JM. Hypointense thrombus on T2-weighted MR imaging: a potential pitfall in the diagnosis of dural sinus thrombosis. Eur J Radiol 2002; 41: 147–152.CrossRefGoogle Scholar
Renowden, S. Cerebral venous sinus thrombosis. Eur Radiol 2004; 14: 215–226.CrossRefGoogle ScholarPubMed
Selim, M, Fink, J, Linfante, I, et al. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol 2002; 59: 1021–1026.CrossRefGoogle ScholarPubMed
Leach, JL, Strub, WM, Gaskill-Shipley, MF. Cerebral venous thrombus signal intensity and susceptibility effects on gradient recalled-echo MR imaging. AJNR Am J Neuroradiol 2007; 28: 940–945.Google ScholarPubMed
Idbaih, A, Boukobza, M, Crassard, I, et al. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke 2006; 37: 991–995.CrossRefGoogle ScholarPubMed
Ding, G, Jiang, Q, Li, L, et al. Angiogenesis detected after embolic stroke in rat brain using magnetic resonance T2*WI. Stroke 2008; 39: 1563–1568.CrossRefGoogle ScholarPubMed
Kassner, A, Roberts, T, Taylor, K, Silver, F, Mikulis, D. Prediction of hemorrhage in acute ischemic stroke using permeability MR imaging. AJNR Am J Neuroradiol 2005; 26: 2213–2217.Google ScholarPubMed
Bang, OY, Buck, BH, Saver, JL, et al. Prediction of hemorrhagic transformation after recanalization therapy using T2*-permeability magnetic resonance imaging. Ann Neurol 2007; 62: 170–176.CrossRefGoogle ScholarPubMed
Gao, T, Wang, Y, Zhang, Z. Silent cerebral microbleeds on susceptibility-weighted imaging of patients with ischemic stroke and leukoaraiosis. Neurol Res 2008; 30: 272–276.CrossRefGoogle ScholarPubMed
Vernooij, MW, Ikram, MA, Wielopolski, PA, et al. Cerebral microbleeds: accelerated 3D T2*-weighted GRE MR imaging versus conventional 2D T2*-weighted GRE MR imaging for detection. Radiology 2008; 248: 272–277.CrossRefGoogle ScholarPubMed
Siemonsen, S, Fitting, T, Thomalla, G, et al. T2′ Imaging predicts infarct growth beyond the acute diffusion-weighted imaging lesion in acute stroke. Radiology 2008; 248: 979–986.CrossRefGoogle ScholarPubMed

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