Arterial Spin Labeling—Can Neurointerventionists Rely on This Novel Technique? A Case Series on Successful Use of Arterial Spin Labeling in Acute Stroke Imaging

K. R. Rahul; P. Santhosh; M. P. Dilip Kumar; Pankaj Mehta; Mathew Cherian

doi:10.1055/s-0037-1603829

Journal of Clinical Interventional Radiology ISVIR, Inhaltsverzeichnis

CC-BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2017; 01(03): 144-149
DOI: 10.1055/s-0037-1603829

Original Article

Indian Society of Vascular and Interventional Radiology

Arterial Spin Labeling—Can Neurointerventionists Rely on This Novel Technique? A Case Series on Successful Use of Arterial Spin Labeling in Acute Stroke Imaging

K. R. Rahul

¹Division of Neuro and Vascular Interventional Radiology, Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

,

P. Santhosh

¹Division of Neuro and Vascular Interventional Radiology, Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

,

M. P. Dilip Kumar

²Division of Interventional Radiology, Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

,

Pankaj Mehta

²Division of Interventional Radiology, Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

,

Mathew Cherian

²Division of Interventional Radiology, Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

› Institutsangaben

Abstract

Presence of ischemic penumbra is the principal factor that decides the need for mechanical thrombectomy in acute stroke patients with large vessel occlusion. Our objective was to evaluate the usefulness of arterial spin labeling (ASL) in detecting diffusion perfusion mismatch and directing patients into mechanical thrombectomy. We retrospectively studied all patients with acute nonhemorrhagic stroke in the anterior circulation, who had undergone stroke imaging with ASL followed by mechanical thrombectomy from July 2016 to November 2016. Area of diffusion perfusion mismatch was graded semiquantitatively into three grades: small, medium, and large. Mismatch was compared with 30-day modified Rankin scale (mRS) score. Interpretable PASL-perfusion images were obtained in all patients. Diffusion perfusion mismatches were present in all patients. Out of six patients with good mRS score, five patients had large diffusion perfusion mismatch. Two out of three patients with poor mRS were secondary to failed recanalization, in spite of large mismatch. One out of nine patients had poor outcome as well as a small area of mismatch. ASL is a rapid noninvasive imaging technique in acute stroke that has got the potential to detect ischemic penumbra.

Keywords

arterial spin labeling - perfusion imaging - diffusion perfusion mismatch - modified Rankin scale score

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