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Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging

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Abstract

Purpose

The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions.

Methods

This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed.

Results

Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex.

Conclusion

The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany

    Tanja Schneider, Tobias Mahraun, Andreas Frölich, Jens Fiehler, Susanne Siemonsen & Jan-Hendrik Buhk

  2. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Julian Schroeder

  3. Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany

    Philip Hoelter

  4. Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany

    Marlies Wagner

  5. Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France

    Jean Darcourt & Christophe Cognard

  6. Départment de Neuroradiologie, Hospitalier Universitaire Gui de Chauliac, Montpellier, France

    Alain Bonafé

Authors
  1. Tanja Schneider
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  2. Tobias Mahraun
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  4. Andreas Frölich
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  10. Jens Fiehler
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  12. Jan-Hendrik Buhk
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Corresponding author

Correspondence to Tanja Schneider.

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Conflict of interests

A. Frölich received speaker fees from Siemens Healthcare Forchheim, Germany. M. Wagner declares that there is a permanent scientific cooperation between Siemens Healthcare AG and the Institute of Neuroradiology of the University Hospital Frankfurt. C. Cognard is consultant/proctor for Stryker, Medtronic, Sequent, Microvention and Codman. A. Bonafé is consultant for Covidien and Stryker. J. Fiehler received lecture or consultancy fees from Acandis, MicroVention, Stryker, Sequent Medical, Codman, Boehringer Ingelheim, Covidien, Philips Healthcare, Siemens Healthcare and Penumbra. J.-H. Buhk received lecture or consultancy fees from Acandis, MicroVention, Stryker, Sequent Medical, Codman and Philips Healthcare. T. Schneider, T. Mahraun, J. Schroeder, P. Hoelter, J. Darcourt and S. Siemonsen declare that they have no conflict of interests.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Additional information

T. Schneider and T. Mahraun are joint first authors.

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Schneider, T., Mahraun, T., Schroeder, J. et al. Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging. Clin Neuroradiol 28, 91–97 (2018). https://doi.org/10.1007/s00062-016-0543-y

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  • DOI: https://doi.org/10.1007/s00062-016-0543-y

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