Ces radiol. 2019, 73(3):167-173 | DOI: 10.55095/CesRadiol2019/024

Evolution of cytotoxic edema in posterior circulation ischemic strokeOriginal article

Jakub Čivrný¹, Tomáš Dorňák², Tomáš Fürst³, Miroslav Heřman¹, Marie Černá¹

¹ Radiologická klinika FN a LF UP v Olomouci

² Neurologická klinika, FN a LF UP v Olomouci

³ Katedra matematické analýzy a aplikací matematiky, PřF UP v Olomouci

Aim: The aim of the study was to examine early ischemic changes evolution on brain MRI as a possible predictor of treatment success in posterior circulation ischemic stroke patients treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT).

Methods: We investigated 106 patients with posterior circulation acute ischemic stroke symptoms treated with IVT alone or IVT and MT. Both initial and early follow-up imaging was evaluated. DWI/FLAIR mismatch was evaluated in 95 patients of known time of onset. Extent end evolution of cytotoxic edema was compared with clinical outcome. Three-month modified Rankin Scale was used to measure the clinical outcome.

Results: The average time of symptom duration in a subgroup with known time of onset (95 out of 106 patients) was 160 minutes (median 140, variance 40-500). DWI/FLAIR mismatch was typical in patients with symptoms duration less than 2 hours. DWI/FLAIR mismatch was present only in approximately half (13/27, 48,2%) of the patients with symptoms duration more than 3 hours. DWI/FLAIR mismatch negative patients had surprisingly better clinical outcome compared to DWI/FLAIR mismatch positive group, although the result was not statistically significant (p = 0.08).
We did not find a single case of total cytotoxic edema reversibility on follow-up MRI. We detected T2 hyperintensity on all follow-up MRIs.

Conclusion: DWI/FLAIR mismatch may help specify time of onset in patients with unknown duration of acute ischemic stroke symptoms. Neither extent nor evolution of cytotoxic edema predicts early response to a therapy or a good clinical outcome. Cytotoxic edema reversal was rare. We did not find a single case of complete cytotoxic edema resolution.

Keywords: acute ischemic stroke, cytotoxic edema, DWI, FLAIR mismatch

Grants and funding:

Práce byla podpořena granty MZ ČR - RVO (FNOL, 00098892) a interním grantem Palackého Univerzity v Olomouci IGA LF 2019-002.

Accepted: September 15, 2019; Published: September 1, 2019  Show citation