Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020;14(10):441-446.
doi: 10.5797/jnet.cr.2020-0072. Epub 2020 Aug 11.

Utility of 3D T2-weighted Sampling Perfection with Application-optimized Contrasts Using Different Flip Angle Evolution (SPACE) and 3D Time-of-flight (TOF) MRA Fusion Imaging in Acute Intracerebral Artery Occlusion

Saya Ozaki  1   2 , Shigetaka Okamoto  3 , Akihiro Inoue  1 , Hitoaki Yasuda  3 , Naoki Shinohara  3
Affiliations
Case Reports

Utility of 3D T2-weighted Sampling Perfection with Application-optimized Contrasts Using Different Flip Angle Evolution (SPACE) and 3D Time-of-flight (TOF) MRA Fusion Imaging in Acute Intracerebral Artery Occlusion

Saya Ozaki et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: The course of the vessel affects the success of recanalization and can cause complications in mechanical thrombectomy (MT); however, no study has been reported a method for outlining vessel course prior to MT. We propose magnetic resonance (MR) fusion images as a useful tool in MT for acute ischemic stroke.

Case presentations: A 73-year-old woman and a 79-year-old man were admitted to our hospital with left hemiparesis. In both patients, MR revealed acute ischemic stroke due to right middle cerebral artery (MCA) occlusion. MR fusion images were created with 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) and 3D time-of-flight (TOF) MRA acquired before MT clearly revealed the occluded right MCA. In both cases, the fusion image is enabled information about the course of the right MCA and its branches to be obtained prior to performing MT. The thrombi were removed with a stent retriever and reperfusion catheter with no complications, and there was remarkable resolution of symptoms in both patients immediately after the procedure.

Conclusion: A fusion image of T2-weighted SPACE and 3D TOF MRA appears to be a simple and effective method for determining the course of the occluded vessel prior to MT for acute ischemic stroke. This technique will enable good recanalization in MT for acute ischemic stroke and should reduce complications.

Keywords: MRI; acute stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1. Images obtained in case 1. 3D TOF MRA at admission shows occlusion of the right MCA at the M2 segment (A). The appearances on angiography (B) were similar to those on MRA (A). Fusion images of 3D T2-weighted SPACE and MRA outline the course of the right MCA distal to the occlusion (C). MRA (D) and angiography (E) images obtained post MT match the reconstructed T2-weighted SPACE images (C). Arrows, double arrows, and arrowheads indicate the same vessels. MCA: middle cerebral artery; MT: mechanical thrombectomy; SPACE: sampling perfection with application-optimized contrasts using different flip angle evolution; TOF: time-of-flight
Fig. 2
Fig. 2. Images obtained in case 1. Original 3D TOF MRA images obtained at admission do not delineate the course of the right MCA distal to the site of obstruction (A–C: white arrows). T2-weighted SPACE images reveal the course of the right MCA distal to the occlusion as low signal in the cistern (D–F: white arrows). MRA after MT matches the T2-weighted SPACE images in terms of visualizing the right MCA distal to the occlusion (G–I: white arrows). MCA: middle cerebral artery; MT: mechanical thrombectomy; SPACE: sampling perfection with application-optimized contrasts using different flip angle evolution; TOF: time-of-flight
Fig. 3
Fig. 3. Images obtained in case 2. 3D TOF MRA at admission shows occlusion of the right MCA at the M1 segment (A). Angiography (B) depicts the occlusion at M1 slightly more distally, but otherwise the appearances are similar to those on MRA (A). Fusion image of 3D T2-weighted SPACE and MRA outlines the course of the right MCA distal to the occlusion (C). MRA (D) and angiography (E) images obtained post MT match the reconstructed T2-weighted SPACE images (C). Arrows, double arrows, and arrowheads indicate the same vessels. MCA: middle cerebral artery; MT: mechanical thrombectomy; SPACE: sampling perfection with application-optimized contrasts using different flip angle evolution; TOF: time-of-flight
Fig. 4
Fig. 4. Images obtained in case 2. Original 3D TOF MRA image obtained at admission does not delineate the course of the right MCA distal to the site of obstruction (A–C: white arrows). T2-weighted SPACE image reveals the course of the right MCA distal to the occlusion as low signal in the cistern (D–F: white arrows). MRA after MT matches the T2-weighted SPACE image in terms of visualizing the right MCA distal to the occlusion (G–I: white arrows). MCA: middle cerebral artery; MT: mechanical thrombectomy; SPACE: sampling perfection with application-optimized contrasts using different flip angle evolution; TOF: time-of-flight
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Goyal M, Menon BK, van Zwam WH, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731. - PubMed
    1. Saber H, Narayanan S, Palla M, et al. : Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis. J Neurointerv Surg 2018; 10: 620–624. - PubMed
    1. Schwaiger BJ, Gersing AS, Zimmer C, et al. : The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke. AJNR Am J Neuroradiol 2015; 36: 971–976. - PMC - PubMed
    1. Amano T, Sato M, Matsumaru Y, et al. : Intra-arterial contrasted cone-beam computed tomography assessment of vessels distal from occluded site in acute ischemic stroke with major vessel occlusion. Neurol Med Chir (Tokyo) 2017; 57: 292–298. - PMC - PubMed
    1. Mitsuoka H, Tsunoda A, Okuda O, et al. : Delineation of small nerves and blood vessels with three-dimensional fast spin-echo MR imaging: comparison of presurgical and surgical findings in patients with hemifacial spasm. AJNR Am J Neuroradiol 1998; 19: 1823–1829. - PMC - PubMed

Publication types