Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.
Diffusion Magnetic Resonance Imaging ; Humans ; Infarction, Middle Cerebral Artery ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stroke ; Thrombectomy

Carotid Artery, Internal ; diagnostic imaging ; Cerebrovascular Disorders ; diagnostic imaging ; physiopathology ; Extremities ; physiopathology ; Humans ; Ischemic Attack, Transient ; complications ; diagnostic imaging ; drug therapy ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; Thromboembolism ; diagnostic imaging ; physiopathology ; Ultrasonography, Doppler, Transcranial

In animal experiments, ischemic stroke is usually induced through middle cerebral artery occlusion (MCAO), and quality assessment of this procedure is crucial. However, an accurate assessment method based on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is still lacking. The difficulty lies in the inconsistent preprocessing pipeline, biased intensity normalization, or unclear spatiotemporal uptake of FDG. Here, we propose an image feature-based protocol to assess the quality of the procedure using a 3D scale-invariant feature transform and support vector machine. This feature-based protocol provides a convenient, accurate, and reliable tool to assess the quality of the MCAO procedure in FDG PET studies. Compared with existing approaches, the proposed protocol is fully quantitative, objective, automatic, and bypasses the intensity normalization step. An online interface was constructed to check images and obtain assessment results.
Animals ; Fluorodeoxyglucose F18 ; Infarction, Middle Cerebral Artery/diagnostic imaging* ; Positron-Emission Tomography/methods*

The histopathological features of the middle cerebral artery (MCA) and superficial temporal artery (STA) from moyamoya disease (MMD) and their relationships with gender, age, angiography stage were explored. The causes and the clinical significance of vasculopathy of STA were also discussed. The clinical data and specimens of MCA and STA from 30 MMD patients were collected. Twelve samples of MCA and STA from non-MMD patients served as control group. Histopathological examination was then performed by measuring the thickness of intima and media, and statistical analysis was conducted. The MCA and STA specimens from MMD group had apparently thicker intima and thinner media than those from the control group. There was no significant pathological difference between the hemorrhage group and non-hemorrhage group, and between the males and females in MMD patients. Neither the age nor the digital subtraction angiography (DSA) stage was correlated with the thickness of intima in MCA and STA. MMD is a systemic vascular disease involving both intracranial and extracranial vessels. Preoperative external carotid arteriography, especially super-selective arteriography of the STA, benefits the selection of donor vessel.
Adult ; Angiography ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; pathology ; Moyamoya Disease ; diagnostic imaging ; pathology ; surgery ; Temporal Arteries ; diagnostic imaging ; pathology ; Tunica Intima ; diagnostic imaging ; pathology

OBJECTIVE: To investigate the diagnostic value of transcranial Doppler ultrasound in early stage cerebral arteriosclerosis. METHODS: We selected 50 patients with early cerebral arteriosclerosis as the disease group. At the same time we selected another 50 patients as a control group with no significant symptoms in the nervous system. By 2 MHz pulse Doppler probe through double-temporal windows and pillow windows Basilar artery (BA), the bilateral middle cerebral artery (MCA) was detected. In the TCD spectrum, we selected the spectrum of a single-family cardiac cycle, identified the starting point (ts), pulse-incisure point (ti), end point (te), and the peak velocity (tp), measured the time of the spectrum starting point to the peak velocity (Tp) and calculated the time required for the peak velocity in the share of ventricular systolic (Tp/Ti), the time required for the peak velocity in the share of the whole cardiac cycle (Tp/T). Tp, Tp/Ti and Tp/T were respectively named as time to peak velocity (TPV), peak-time index-1 (PTI-1) and peak-time index-2 (PTI-2). All data were analyzed by SPSS13.0. RESULTS: There was no significant difference in blood vessel velocity, PI, RI and S/D of BA and RMCA (P>0.05) between the control group and the disease group. Compared with the control group, TPV of the BA, LMCA and RMCA significantly extended, PTI-1 and PTI-2 of BA, LMCA and RMCA increased significantly in the disease group (P<0.01). In the disease group, there was no significant correlation between peak time index and PI, S/D (P>0.05). CONCLUSION TPV, PTI-1 and PTI-2 are sensitive indicators of early stage cerebral arteriosclerosis.
Adult ; Basilar Artery ; diagnostic imaging ; Blood Flow Velocity ; physiology ; Case-Control Studies ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnostic imaging ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography, Doppler, Transcranial

OBJECTIVETo explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA).

METHODSFrom January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated.

RESULTSThe abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%.

CONCLUSIONThe reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.

Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Arteriosclerosis ; diagnosis ; Cerebral Arteries ; diagnostic imaging ; Cerebrovascular Disorders ; diagnosis ; diagnostic imaging ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Ultrasonography ; Vertebral Artery ; abnormalities ; diagnostic imaging

Brain ; blood supply ; Fetus ; blood supply ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Infant, Newborn ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography, Doppler, Color ; Ultrasonography, Prenatal

OBJECTIVETo evaluate the hemodynamic changes in the central branches of the middle cerebral artery in different stages of neonatal hypoxic-ischemic encephalopathy (HIE) and provide new evidence for clinical diagnosis of HIE.

METHODSFrom March, 2013 to July, 2013, a total of 136 newborn infants were diagnosed to have HIE in our center. We performed two-dimensional ultrasonography and color Doppler ultrasound for assessments of systolic velocity (Vs) and resistant index (RI) of the central branches of the middle cerebral artery. The data were compared with the results of a control group consisting of 251 normal full-term infants.

RESULTSInfants with mild HIE showed hyperechoic changes in the white matter around the ventricle, while in moderate and severe HIE, such hyperechoic changes were diffuse in both hemispheres with unclear echoes of the brain structures. Pulse Doppler assessments of hemodynamics of the central branches of the middle cerebral artery demonstrated a significant decrease in Vs and an increase in RI regardless of HIE severity (P<0.05). In addition, Vs and RI values in mild HIE infants differed significantly (P<0.05) from those in infants with moderate and severe HIE, who had comparable Vs and RI values (P>0.05).

CONCLUSIONTranscranial ultrasonography may provide dynamic information on cerebral blood flow in neonates and hemodynamic parameters of the central branches of the middle cerebral artery are valuable for clinical diagnosis and early intervention of HIE.

Brain ; blood supply ; Cerebrovascular Circulation ; Hemodynamics ; Humans ; Hypoxia-Ischemia, Brain ; diagnostic imaging ; Infant ; Infant, Newborn ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography

Aged ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; diagnostic imaging ; physiopathology ; therapy ; Cerebral Arterial Diseases ; diagnostic imaging ; physiopathology ; therapy ; Cerebral Arteries ; diagnostic imaging ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Renal Artery ; diagnostic imaging ; Renal Artery Obstruction ; diagnostic imaging ; physiopathology ; therapy ; Risk Factors ; Stents ; Tomography, X-Ray Computed

PURPOSE: Lacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke. MATERIALS AND METHODS: This study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression. RESULTS: The mean infarct volume and PI were 482.18±406.40 mm3 and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm3 in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022). CONCLUSION: We demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.
Aged ; Cerebral Infarction/*diagnostic imaging/*physiopathology ; *Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Middle Cerebral Artery ; Pulsatile Flow/physiology ; Retrospective Studies ; Stroke, Lacunar/*diagnostic imaging/*physiopathology ; *Ultrasonography, Doppler, Transcranial ; Vascular Resistance/physiology