Clinical Utility of Prominent Hypointense Signals in the Draining Veins on Susceptibility-Weighted Imaging in Acute Cerebral Infarct: As a Marker of Penumbra and a Predictor of Prognosis
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Purpose : A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signalsin the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose ofthis study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas ofimpaired perfusion and to investigate the usefulness of PHSV in predicting prognosis of cerebral infarction. Materials and Methods: In 18 patients with acute cerebral infarction who underwent brain MRI with diffusion-weightedimaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacentto areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normalappearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change inthe extent of infarction in follow-up images was analyzed. Results: Of the 18 patients, 10 patients showed progression of the infarction, and 8 patients showed little change on follow-up imaging. On SWI, of the 10 patients with progression 9 patients showed peripheral PHSV and the newly developedinfarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSVshowed progression of the infarct. The patients with infarction progression revealed significantly higher presence ofperipheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients withlittle change. Conclusion: SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict theprognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predictingprognosis of acute cerebral infarction.
Abstract
Purpose : A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signalsin the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose ofthis study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas ofimpaired perfusion and to investigate the usefulness of PHSV in predicting prognosis of cerebral infarction. Materials and Methods: In 18 patients with acute cerebral infarction who underwent brain MRI with diffusion-weightedimaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacentto areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normalappearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change inthe extent of infarction in follow-up images was analyzed. Results: Of the 18 patients, 10 patients showed progression of the infarction, and 8 patients showed little change on follow-up imaging. On SWI, of the 10 patients with progression 9 patients showed peripheral PHSV and the newly developedinfarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSVshowed progression of the infarct. The patients with infarction progression revealed significantly higher presence ofperipheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients withlittle change. Conclusion: SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict theprognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predictingprognosis of acute cerebral infarction.
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