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Multiple antiplatelet therapy contributes to the reversible high signal spots on diffusion-weighted imaging in elective coiling of unruptured cerebral aneurysm

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Our aim was to systematically investigate radiographic characteristics and outcome of diffusion-weighted imaging (DWI) changes in the elective coiling of unruptured cerebral aneurysm with analyzing the correlation of antiplatelet therapy (APT).

Methods

In a total of 34 consecutive patients with unruptured cerebral aneurysms initially treated by coiling without stent assist, 26 (76.5 %) had DWI changes with 91 high signal spots within 24–48 h after the procedure. We recorded DWI parameters (location, volume, mean, and minimum values of the apparent diffusion coefficient: expressed as ADCAVE and ADCMIN) for each lesion, and evaluated its radiographic outcome on conventional MRI at follow-up (interval, 58.4 ± 37.2 days) in the modes of APT.

Results

All patients with DWI high spots had no clinical symptoms. There was a strong correlation between ADCAVE and ADCMIN (r = 0.82, p < 0.0001). The mean ADCAVE and rADCAVE were 0.74 ± 0.14 × 10−3 mm2/s and 87 ± 10 %. DWI high spots were small with a mean volume of 0.13 ± 0.12 cm3, ranging from 0.04 to 0.86 cm3. A negative correlation was observed between the volume and values of ADCAVE (r = −0.48, p < 0.0001). The DWI volume was significantly larger in single APT than in multiple (0.15 ± 0.14 versus 0.10 ± 0.07 cm3, p = 0.0091). The permanent signal change was more observed in single APT than in multiple (24.5 % versus 5.2 %, p = 0.02).

Conclusion

DWI high spots after elective coiling were small without significant decrease of ADC, and do not correspond to brain infarction. Periprocedural use of multiple antiplatelet agents is expected to reduce the volume of thromboembolism and permanent tissue damages.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Toshinori Matsushige, Takahito Okazaki, Katsuhiro Shinagawa, Nobuhiko Ichinose & Kaoru Kurisu

  2. Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan

    Yoshihiro Kiura & Shigeyuki Sakamoto

  3. Department of Clinical Oncology and Neuro-oncology Program, Cancer Treatment Center, Hiroshima University Hospital, Hiroshima, Japan

    Kazuhiko Sugiyama

  4. Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan

    Miyuki Takasu & Yuji Akiyama

Authors
  1. Toshinori Matsushige
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  2. Yoshihiro Kiura
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  3. Shigeyuki Sakamoto
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  4. Takahito Okazaki
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  5. Katsuhiro Shinagawa
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  6. Nobuhiko Ichinose
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  7. Miyuki Takasu
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  8. Yuji Akiyama
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  9. Kazuhiko Sugiyama
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  10. Kaoru Kurisu
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Corresponding author

Correspondence to Toshinori Matsushige.

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Author contribution

The guarantor of integrity of the entire study was Kaoru Kurisu. Toshinori Matsushige and Yuji Akiyama were responsible for study concepts, while Toshinori Matsushige and Shigeyuki Sakamoto for study design. Definition of intellectual content was done by Toshinori Matsushige, and literature research was done by Toshinori Matsushige. Clinical studies were done by Yoshinori Kiura, Shigeyuki Sakamoto, Takahito Okazaki, Katsuhiro Shinagawa, and Nobuhiko Ichinose. Toshinori Matsushige, Katsuhiro Shinagawa, and Miyuki Takasu were responsible for data acquisition. Data analysis was done by Toshinori Matsushige and Miyuki Takasu, while statistical analysis was done by Toshinori Matsushige. Toshinori Matsushige was responsible for manuscript preparation; Toshinori Matsushige for manuscript editing; and Miyuki Takasu, Kazuhiko Sugiyama, and Kaoru Kurisu for manuscript review.

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Matsushige, T., Kiura, Y., Sakamoto, S. et al. Multiple antiplatelet therapy contributes to the reversible high signal spots on diffusion-weighted imaging in elective coiling of unruptured cerebral aneurysm. Neuroradiology 55, 449–457 (2013). https://doi.org/10.1007/s00234-013-1137-x

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  • DOI: https://doi.org/10.1007/s00234-013-1137-x

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