Abstract TP51: Decreased Internal Cerebral Vein Filling - A New Radiographic Sign of Acute Ischemic Stroke
INTRODUCTION: CT signs of acute ischemic stroke focus on parenchymal and arterial lesions. Little is known about venous changes. The aim of this study was to determine the value of decreased deep venous outflow as a predictor of acute ischemic stroke.
METHODS: Multimodal CT findings of 182 patients presenting for acute stroke evaluation within 4.5 hours of symptom onset were retrospectively reviewed for evidence of deep venous outflow changes. Interhemispheric symmetry of internal cerebral vein (ICV) opacification on CT angiogram was assessed by 3 raters. Discharge diagnosis, neurological assessment details, and radiographic data were extracted from electronic hospital records, and radiology reports.
RESULTS: Of 182 patients included in the study, 46 showed diminished ICV opacification (dICV) on the side of the expected ischemic lesion. Anterior circulation stroke was diagnosed in 87% of dICV cases, but in only 31% of subjects with ICV symmetry (sICV), suggesting a strong correlation of dICV with ipsilateral anterior circulation infarction (P<0.0001). Patients with dICV presented with greater neurologic impairment (NIHSS 14±1.0 vs. 6±0.8, P<0.0001), proximal arterial lesions, and lower ASPECTS (8±0.3 vs. 9±0.2, P=0.0022). In 48 patients who had a CT perfusion scan at the time of initial evaluation (dICV N=20 vs. sICV N=28), dICV was associated with larger perfusion defects: mean transit time ASPECTS 3±0.7 vs. 8±0.3 (P<0.0001), cerebral blood flow ASPECTS 3±0.8 vs. 8±0.5 (P<0.0001), and cerebral blood volume ASPECTS 7±0.7 vs. 9±0.2 (P=0.006). The sensitivity, specificity, and positive predictive value of dICV for anterior circulation stroke were 48%, 94%, and 87% respectively. Inter-rater agreement was very good with a free marginal kappa of 0.75.
CONCLUSION: Decreased ICV may be a useful radiographic sign of ipsilateral acute ischemic stroke and a marker of a large cerebral territory at risk of infarction. Prospective studies are needed to help validate this finding, and its role in predicting stroke outcomes.
- © 2012 by American Heart Association, Inc.