Skip to main content

Advertisement

SpringerLink
Log in

Infarct fogging on immediate postinterventional CT—a not infrequent occurrence

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

A pseudo-normalization of infarcted brain parenchyma, similar to the “fogging effect” which usually occurs after 2–3 weeks, can be observed on CT performed immediately after endovascular stroke treatment (EST). Goal of this study was to analyze the incidence of this phenomenon and its evolution on follow-up imaging.

Methods

One hundred fifty-two patients in our database of 949 patients, who were treated for acute stroke between January 2010 and January 2015, fulfilled the inclusion criteria of (a) EST for an acute stroke in the anterior circulation, (b) an ASPECT-score < 10 on pre-interventional CT, and (c) postinterventional CT imaging within 4.5 h after the procedure. Two independent reviewers analyzed imaging data of these patients.

Results

Transformation of brain areas from hypoattenuated on pre-interventional CT to isodense on postinterventional CT was seen in 37 patients in a total of 49 ASPECTS areas (Cohen’s kappa 0.819; p < 0.001). In 17 patients, the previously hypoattenuated brain areas became isodense, but appeared swollen. In 20 patients (13%), the previously hypodense brain area could not be distinguished from normal brain parenchyma. On follow-up imaging, all isodense brain areas showed signs of infarction.

Conclusion

Pseudo-normalization of infarct hypoattenuation on postinterventional CT is not infrequent. It is most likely caused by contrast leakage in infarcted parenchyma and does not represent salvage of ischemic brain parenchyma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berkhemer OA, Fransen PS, Beumer D, MR CLEAN Investigators et al (2009) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20. doi:10.1056/NEJMoa1411587

    Article  Google Scholar 

  2. Kim JT, Heo SH, Cho BH, Choi SM et al (2012) Hyperdensity on non-contrast CT immediately after intra-arterial revascularization. J Neurol 259:936–943

    Article  PubMed  Google Scholar 

  3. Parrilla G, García-Villalba B, Espinosa de Rueda M et al (2012) Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol 33:1791–1796

    Article  CAS  PubMed  Google Scholar 

  4. Lummel N, Schulte-Altedorneburg G, Bernau C et al (2014) Hyperattenuated intracerebral lesions after mechanical recanalization in acute stroke. AJNR Am J Neuroradiol 35:345–351

    Article  CAS  PubMed  Google Scholar 

  5. Nikoubashman O, Reich A, Gindullis M, Frohnhofen K, Pjontek R, Brockmann MA, Schulz JB, Wiesmann M (2014) Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke. Neuroradiology 56:41–50. doi:10.1007/s00234-013-1303-1

    Article  PubMed  Google Scholar 

  6. Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, De Blauwe S, Hemelsoet D, Wiesmann M, Defreyne L (2016) Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough. J Neurointerv Surg. doi:10.1136/neurintsurg-2016-012290

  7. Pexman JH, Barber PA, Hill MD et al (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22:1534–1542

    CAS  PubMed  Google Scholar 

  8. Trouillas P, von Kummer R (2006) Classification and pathogenesis of cerebral hemorrhages after thrombolysis in ischemic stroke. Stroke 37:556–561. doi:10.1161/01.STR.0000196942.84707.71

    Article  PubMed  Google Scholar 

  9. Becker H, Desch H, Hacker H et al (1979) CT fogging effect with ischemic cerebral infarcts. Neuroradiology 18:185–192

    Article  CAS  PubMed  Google Scholar 

  10. Bech Skriver E, Skyhoj Olsen T (1981) Transient disappearance of cerebral infarcts on CT scan, the so-called fogging effect. Neuroradiology 22:61–65

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, Onze-Lieve-Vrouw (OLV) Ziekenhuis Aalst, Moorselbaan 164, 9300, Aalst, Belgium

    Sven Dekeyzer

  2. Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Sven Dekeyzer, Martin Wiesmann & Omid Nikoubashman

  3. Department of Neurology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Arno Reich

  4. Department of Radiology, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany

    Ahmed E. Othman

Authors
  1. Sven Dekeyzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arno Reich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed E. Othman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Wiesmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Omid Nikoubashman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sven Dekeyzer.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

MW has received grants from Stryker Neurovascular and Siemens Healthcare; personal fees from Stryker Neurovascular, Silkroad Medical, Siemens Healthcare and Bracco; and non-financial support from Codman Neurovascular, Covidien, Abbott, St. Jude Medical, Phenox, Penumbra, Microvention/Terumo, B. Braun, Bayer, Acandis and ab medica.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dekeyzer, S., Reich, A., Othman, A.E. et al. Infarct fogging on immediate postinterventional CT—a not infrequent occurrence. Neuroradiology 59, 853–859 (2017). https://doi.org/10.1007/s00234-017-1894-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-017-1894-z

Keywords

Search

Navigation