J Korean Soc Magn Reson Med.  2014 Dec;18(4):332-340. 10.13104/jksmrm.2014.18.4.332.

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

• Lee HS
• Ahn KJ
• Choi HS
• Jang JH
• Jung SL
• Kim BS
• Yang DW

• KMID: 2206930
• DOI: http://doi.org/10.13104/jksmrm.2014.18.4.332

Abstract

PURPOSE
A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signals in the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas of impaired 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-weighted imaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacent to areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normal appearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change in the 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 developed infarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSV showed progression of the infarct. The patients with infarction progression revealed significantly higher presence of peripheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients with little change.
CONCLUSION
SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict the prognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predicting prognosis of acute cerebral infarction.

Keyword

Cerebral infarction; Magnetic resonance (MR); Susceptibilty-weighted imaging (SWI); Prominent hypointense signals in the draining veins (PHSV)

MeSH Terms

Brain
Cerebral Infarction
Follow-Up Studies
Humans
Infarction
Magnetic Resonance Imaging
Perfusion
Prognosis*
Veins*

Figure

• 

  Fig. 1 Images of a 87-year-old male with acute stroke. a. Initial DWI shows an acute infarct in the right middle cerebral artery territory. b. SWI obtained on the same day shows peripheral PHSV in the posterior aspect of infarction. c. Follow-up DWI 9 days after the attack shows progression of the extent of infarction as compared to (a).

• 

  Fig. 2 Images of a 51-year-old female with acute stroke. a. DWI shows a large acute infarct in the left frontoparietal lobe. b. Core PHSV is detected in the initial SWI. c. Follow-up T2 weighted-imaging 3 days after the attack shows no discernable change in the extent of infarction without further progression when compared to (a).

• 

  Fig. 3 Images of a 70-year-old female with acute stroke. a. DWI shows an acute infarct in the left temportal lobe. b. Although multifocal hemorrhagic foci are noted, PHSV is not detected in the infarction area on SWI. c. Follow-up T2 weighted-imaging 9 days after the attack shows no progression of the extent of infarction.

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