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Monitoring cerebral blood flow change through use of arterial spin labelling in acute ischaemic stroke patients after intra-arterial thrombectomy

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Abstract

Objectives

To evaluate the ability of arterial spin labelling perfusion-weighted imaging (ASL-PWI) to identify reperfusion status and to predict the early neurological outcome of acute ischaemic stroke patients after intra-arterial (IA) thrombectomy.

Methods

A total of 51 acute ischaemic stroke patients who underwent IA thrombectomy were retrospectively reviewed. Asymmetrical index before and after IA thrombectomy (AICBFpre and AICBFpost) and volume ratio of the reperfused territory to the baseline perfusion abnormality (reperfusion volume ratio) were calculated on ASL-PWI. A paired t-test was used to compare AICBFpre and AICBFpost. Pearson correlation and multiple linear regression were performed to evaluate correlations between the imaging parameters and NIHSS scores.

Results

Mean AICBFpost was significantly higher than mean AICBFpre (0.923±0.352 vs. 0.312±0.191, p<0.001). AICBFpre had a significant correlation with NIHSSpre (pr=–0.430, p=.004). ∆AICBF had significant correlations with NIHSS24 h, NIHSS5-7 days and ∆NIHSS5-7 days (r=–0.356, p=0.028; r=–0.597, p<0.001; r=–0.346, p=0.033, respectively). ∆AICBF, reperfusion volume ratio and baseline infarct volume were significant independent predictors for NIHSS5-7 days.

Conclusions

ASL-PWI has the potential to serve as a non-invasive imaging tool to monitor the reperfusion status and predict the early neurological outcome of acute ischaemic stroke patients after IA thrombectomy.

Key Points

• CBF change on ASL-PWI after IA thrombectomy correlated with NIHSS scores.

• ASL-PWI can non-invasively monitor reperfusion in AIS patients after IA thrombectomy.

• ASL-PWI may predict early outcome of AIS patients after IA thrombectomy.

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Abbreviations

3D:

Three-dimensional

AICBF:

Asymmetrical index of cerebral blood flow

AIS:

Acute ischaemic stroke

ASL-PWI:

Arterial spin labelling perfusion-weighted imaging

ASPECTS:

Alberta Stroke Program Early CT Score

CBF:

Cerebral blood flow

DSC-PWI:

Dynamic susceptibility contrast-enhanced perfusion-weighted imaging

DWI:

Diffusion-weighted imaging

FLAIR:

Fluid-attenuated inversion recovery

IA:

Intra-arterial

ICA:

Internal carotid artery

IQR:

Interquartile range

mTICI:

Modified Treatment in Cerebral Ischemia Scale

NIHSS:

National Institutes of Health Stroke Scale

ROI:

Region of interest

SWI:

Susceptibility-weighted imaging

TOF:

Time-of-flight

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Roh-Eul Yoo, Tae Jin Yun, Dong Hyun Yoo, Young Dae Cho, Koung Mi Kang, Seung Hong Choi, Ji-hoon Kim & Chul-Ho Sohn

  2. Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Roh-Eul Yoo, Tae Jin Yun, Dong Hyun Yoo, Young Dae Cho, Koung Mi Kang, Seung Hong Choi, Ji-hoon Kim & Chul-Ho Sohn

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea

    Hyun-Seung Kang

  4. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea

    Byung-Woo Yoon & Keun-Hwa Jung

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  1. Roh-Eul Yoo
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Correspondence to Tae Jin Yun.

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The scientific guarantor of this publication is Tae Jin Yun.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yoo, RE., Yun, T.J., Yoo, D.H. et al. Monitoring cerebral blood flow change through use of arterial spin labelling in acute ischaemic stroke patients after intra-arterial thrombectomy. Eur Radiol 28, 3276–3284 (2018). https://doi.org/10.1007/s00330-018-5319-0

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  • DOI: https://doi.org/10.1007/s00330-018-5319-0

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