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Megan Aumann¹, Jarrod J Eisma¹, Alexander K Song¹, Spencer L Waddle¹, Sky Jones¹, Meher R Juttukonda², Niral J Patel³, Samantha Davis¹, Taylor Davis^1,2, Lori Jordan^1,4, and Manus J Donahue^1
1Neurology, Vanderbilt University Medical Center, Nashville, TN, United States, ²Radiology, Vanderbilt University Medical Center, Nashville, TN, United States, ³Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN, United States, ⁴Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States

Keywords: Stroke, Stroke, metabolism

Two common treatment paradigms for sickle cell disease (SCD) include oral medication hydroxyurea and blood transfusions. Rarely, a curative hematopoietic stem cell transplant (HSCT) is performed. We utilized non-invasive MRI to evaluate how potential biomarkers of infarct risk, cerebral blood flow (CBF) and oxygen extraction fraction (OEF), change in these treatment paradigms (cumulative n=39). Hydroxyurea treatment did not have significant changes to hemoglobin, CBF, or OEF between two scans. Hemoglobin increases by approximately 8.73 and 64.11% for adults with SCD on transfusion and transplant treatments, respectively. These changes most prominently parallel a reduction in CBF of 20.46 and 31.67%, respectively.

Yu Guo¹, Weiqiang Dou², Xinyu Wang³, Xinyi Wang¹, Huimin Mao¹, and Kunjian Chen^1
1The First Affiliated Hospital of Shandong First Medical University＆Shandong Provincial Qianfoshan Hospital, Jinan, China, ²MR Research, GE Healthcare, Beijing , China., Beijing, China, ³Beijing Chaoyang Hospital, Capital Medical University, Beijing , China., Beijing, China

Keywords: Stroke, Multimodal

This study aimed to investigate whether the combined T1w-CUBE imaging and multiple post-labeling delay 3D pseudo-continuous arterial spin labeling imaging（MP 3D-PcASL）can distinguish moyamoya disease（MMD）from arteriosclerotic moyamoya syndrome（AS-MMS）. 26 MMD patients and 25 AS-MMS patients were measured with T1w-CUBE imaging and MP 3D-PcASL. Significantly altered vessel wall in morphology and cerebral perfusion patterns were found on the lesions between AS-MMS and MMD. We thus concluded that the combined T1w-CUBE imaging and MP 3D-PcASL might help distinguish MMD from AS-MMS in clinic.

Jie Yang¹, Jianquan Zhong¹, Minli Lv¹, Yan Li ¹, Limei Han^1,2, Hao Feng¹, Chaoliang He^1,3, Chunyan Zheng¹, Zhejun Wang¹, and Yunzhu Wu^4
1Department of Radiology, Zigong First People's Hospital, Zigong, China, ²North Sichuan Medical College, Nanchong, China, ³Sichuan Vocational College of Health and Rehabilitation, Zigong, China, ⁴MR Scientific Marketing, SIEMENS Healthineers Ltd., Shanghai, China

Keywords: Stroke, Blood vessels, Iron Deposition

In this study, QSM was used to investigate susceptibility differences among infarct region, non- infarct regions of responsible artery and non-responsible artery in acute ischemic stroke (AIS) patients. The results showed that only susceptibility of the infarct region was significantly higher than that of healthy controls. In AIS patients, the susceptibility of infarct region were significantly higher than those of normal cerebral artery regions and non-infarction regions of responsible artery. These results suggest that abnormal iron deposition exists in the infarct region and may not affect other non-infarct regions.

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Dongsuk Sung¹, Peter A Kottke², Jason W Allen^1,3,4, Fadi Nahab⁴, Andrei G Fedorov^2,5, and Candace C. Fleischer^1,3,5
1Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, United States, ²Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States, ³Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States, ⁴Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States, ⁵Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, United States

Keywords: Stroke, Thermometry

Prior research has demonstrated the benefits of endovascular thrombectomy after acute ischemic stroke. Despite improvements in surgical techniques, patient selection for thrombectomy remains challenging. In this case study, we explored the utility of brain temperature to accurately predict infarct core and salvageable tissue to stratify patients for thrombectomy. We observed infarct volume estimated from temperature maps was more similar than CT perfusion to the true infarct volume identified using apparent diffusion coefficient images from diffusion weighted imaging. Temperature-based ischemia-to-infarct ratio showed better patient stratification than conventional methods, suggesting the complementary use of brain temperature in patient selection after ischemic stroke.

Yue Qin¹, Xin Li¹, Yifan Qian¹, Xiaoshi Li¹, and Lei Wang^1
1Xi'an Daxing Hospital, Xi'an, China

Keywords: Stroke, Diffusion/other diffusion imaging techniques

This present study used diffusion tensor image analysis along the perivascular space (DTI-ALPS) method to investigate the glymphatic activity of the corticospinal tract in subacute ischemic stroke patients with impaired motor function. We found that the subacute ischemic stroke group had a lower DTI-ALPS value on the affected side of corticospinal tract, suggesting impairment of the glymphatic system in patients with subacute ischemic stroke, which may be related to motor dysfunction.

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jianbin huang¹, peng hao¹, zelong chen¹, kan deng², baoer liu¹, and yikai xu^1
1nanfang hospital, guangzhou, China, ²Philips Healthcare, guangzhou, China

Keywords: Stroke, Brain

Hemorrhagic transformation (HT) is a potentially life-threatening complication in acute ischemic stroke (AIS) patients. We developed a quantitative of hyperperfusion on ASL and to evaluate its value in the prediction of HT in AIS patients. Our results indicated that CBFmax in hyperperfusion detected on pretreatment ASL was associated with subsequent HT and higher CBFmax was more likely to experience parenchymal hematoma (PH) in AIS patients. The assessment of CBFmax in hyperperfusion on pretreatment ASL may be available in routine clinical practice to further predict subsequent HT and enable timely intervention to prevent PH.

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Ling Li¹, Xiaoling Zhang¹, Xiaoyan Lei¹, Min Tang¹, Xuejiao Yan¹, Yu Wen¹, Jing Zhang¹, and Kai Ai^2
1Department of MRI, Shaanxi Provincial People's Hospital, Xi’an, China, ²Philips Healthcare, Xi’an, China

Keywords: Vessel Wall, Atherosclerosis, ASL, transient ischemic attack

In order to prevent TIA patients from further developing into irreversible stroke, it is important to predict the occurrence of stroke in TIA patients. In this study, high-resolution magnetic resonance imaging (HRMRI) and arterial spin labeling (ASL) were used to investigate the differences of middle cerebral artery (MCA) plaque and hemodynamics in patients with ischemic stroke and TIA, and to establish a predictive model for ischemic stroke. The results showed that positive remodeling, enhancement ratio and 2.5s ATA present could be used to predict the occurrence of stroke in patients with TIA, and the prediction model had excellent diagnostic performance.

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Qin Wen¹, Xingke Huang¹, Yun Su¹, Zhuoheng Yan¹, Chen Zhao², Zhiwei Shen³, Jiaji Mao¹, and Jun Shen^1
1Department of Radiology, Sun Yat-Sen Memorial Hospital，Sun Yat-Sen University, Guangzhou, China, ²Philips Healthcare, Guangzhou, China, ³Philips Healthcare, Beijing, China

Keywords: Stroke, CEST & MT, Glutamate

This study investigated the feasibility of GluCEST at 3.0 T for detecting the change of glutamate in the human brain after stroke. The imaging capability of glutamate is validated on the phantom and human brain, respectively. Glutamate at physiological concentrations could be detected by in vitro MRI. The findings of an in vivo investigation revealed that the GluCEST signal of stroke patients differs from that of healthy individuals and that this difference may be detected by 3.0 T MRI. This work provides fresh insights into the use of endogenous glutamate MRI imaging.

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Yi Li¹, Di Wu², Xiaoyun Liang¹, Zihan Li³, Pinjia Cai³, Feng Huang¹, and Wenzhen Zhu^2
1Neusoft Medical Systems Co., Ltd, Shanghai, China, ²Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, ³Neusoft Medical Systems Co., Ltd, Shenyang, China

Keywords: Stroke, Stroke, DWI-ASL Mismatch, Collaterals, Subacute troke, Prognosis

As a contrast agent-free MR imaging, ASL will not cause contrast agent-associated nephrotoxicity and allergic reaction. However, low image resolution makes it time-consuming and difficult for clinicians to quantify hypoperfusion volumes using ASL. We developed an automatic and robust algorithm to quantify core-penumbra mismatch based on DWI-ASL. Furthermore, models were built with clinical and/or imaging features and their performances in predicting prognosis of subacute stroke patients were evaluated. When combining infarct location and collaterals with NIHSS, but not mismatch ratio, the model can predict prognosis of subacute stroke patients the best. Therefore, this may add benefits to delayed intervention.

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huang shan shan^1
1Xi’an No.1 Hospital, Xi'an, China

Keywords: Stroke, Thrombo-Embolic

To investigate the predictive value of baseline DWI-pcASPECTS combined with MRA-collateral circulation score in patients with acute posterior circulation ischemic stroke after mechanical thrombectomy. DWI-pcASPECTS score and MRA-collateral circulation score before treatment were retrospectively analyzed in patients with acute posterior circulation ischemic stroke after mechanical thrombolectomy.  Multivariate Logistic regression was used to analyze the independent predictors of functional outcomes 90 days after mechanical thrombectomy. MR-pcASCO score can be used as an important means to predict the prognostic function of patients with acute posterior circulation ischemic stroke after mechanical thrombectomy.
 

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Xin Wang¹, Caihong Wang¹, Jingchun Liu², Jun Guo³, Peifang Miao¹, Ying Wei¹, Kaiyu Wang⁴, Jingliang Cheng¹, and Cuiping Ren^1
1Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China, ³Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China, ⁴MR Research China, GE Healthcare, Beijing, China

Keywords: Stroke, Brain

We aimed to investigate the static and dynamic characteristics of brain activity after stroke by using functional magnetic resonance imaging (fMRI). Seventy-three patients with pontine ischemic stroke and 50 healthy controls (HCs) were recruited and received a resting-state fMRI scanning. Our result shows that there are significantly altered sALFF/dALFF and sReHo/dReHo values in the brain regions of patients. And the alterations of dynamic brain activity in the basal ganglia and cerebellum were correlated with the degree of cognitive impairment. Static and dynamic biomarkers can be combined together to provide more comprehensive information on potential therapeutic targets.

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Haiyan Gui¹, Ningdi Yang¹, Jianxiu Lian², Qingyan Xia¹, and Jiaxiu Du^1
1The fourth hospital of Harbin, Harbin, China, ²Philips Healthcare, Beijing, China

Keywords: Blood vessels, Brain

Cerebrovascular diseases are one of the main causes of death and disability in the adult population. Functional magnetic resonance imaging (fMRI) could provide quantitative parameters to evaluate the process of diseases, including Diffusion-weighted imaging（DWI）, three-dimensional arterial spin labeling (3D ASL), and 4D-TRANCE. Results showed the maximum area size of 3D-ASL and 4D-TRANCE had predictive significance when evaluating patients with acute ischemic cerebral infarction by National Institutes of Health Stroke Scale (NIHSS) score, which could provide objective and useful parameters in further diagnosis.

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Jamini Bhagu^1,2 and Samuel Colles Grant^1,2
1National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, United States, ²Chemical & Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, FL, United States

Keywords: Stroke, Non-Proton, sodium, MCAO

This study evaluates the therapeutic efficacy of transplanted extracellular vesicles (EV) secreted from 3D aggregated human mesenchymal stem cells to treat transient ischemic stroke in a female rat model. The objective is to verify the presence of EV at the lesion and monitor tissue recovery using T₂- and diffusion-weighted MRI at 21.1 T. 

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Lara Buscemi ¹, Mario Lepore², Thanh Phong Lê³, Lorenz Hirt¹, and Mor Mishkovsky^3
1Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland, ²Center for Biomedical Imaging, EPFL, Lausanne, Switzerland, ³Laboratory of Functional and Metabolic Imaging, EPFL, Lausanne, Switzerland

Keywords: Stroke, Preclinical

A considerable sex bias exists in preclinical research, with studies on male animals outnumbering those in females, yet several preclinical rodent studies of transient middle cerebral artery occlusion (tMCAO) reported that infarct volume is smaller in females than in males. As the neurochemical profile greatly evolves after stroke, the present study aimed to evaluate whether the neurochemical profile is modified differently between male and female mice post tMCAO.  We found that baseline values apart from taurine show no differences as previously reported. However, a difference in the metabolic profile between male and female mice becomes visible after tMCAO.

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Zhengxiong Wang¹, Yongzhou Xu², Peng Wu³, Lu Han³, and Xinhua Wei^1
1Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China, ²Philips Healthcare, Guangzhou, China, ³Philips Healthcare, Shanghai, China

Keywords: Stroke, Ischemia, ischemic stroke, Multi-parametric Z-spectral MRI, lesions

Multi-parametric Z-spectral MRI has been successfully implemented in vivo. In this study, multi-contrast Z-spectra fitted with four Lorentzian functions were acquired from eighteen ischemic stroke patients. We found that this novel method could differentiate lesions from normal brain tissues, and multiple Z-spectral contrasts showed a satisfying correlation with the apparent diffusion coefficient (ADC). Multi-parametric Z-spectral MRI could specifically characterize the metabolic alterations of ischemic brain tissues in stroke patients. 

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Thomas Lilieholm¹, Matthew Larson², Azam Ahmed³, and Walter F Block^1,2,4
1Medical Physics, University of Wisconsin - Madison, Madison, WI, United States, ²Radiology, University of Wisconsin - Madison, Madison, WI, United States, ³Neurosurgery, University of Wisconsin - Madison, Madison, WI, United States, ⁴Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, United States

Keywords: Stroke, Blood

Previous deep learning networks have autonomously identified, segmented, and quantified hematoma volumes in MR images of intracerebral hemorrhages (ICH). This information derived from this analysis would periodically augment surgical decisions during minimally invasive ICH evacuations. A limitation of these autonomous processes is the MRI contrast variations with varying clot ages precludes a generalizable CNN for ICH. We propose a multiparametric image processing pipeline for categorizing clots on the basis of their age, as determined by presented image contrast relative to local white matter.  This determination can be used to select a properly trained CNN model based on age classification.

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Daniel Sare¹, Daniel Li¹, Bryan Kartono¹, Adam Waspe^2,3, and Andrea Kassner^1,3
1Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada, ²Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada, ³Department of Medical Imaging, The University of Toronto, Toronto, ON, Canada

Keywords: Stroke, Brain

Pediatric stroke remains a significant cause of lifelong neurological impairment and morbity. Treatment options and our understanding of stroke evolution in the developing brain, especially beyond the peri- and neonatal period, is still limited. By using a photothrombotic juvenile rat stroke model and quantitative MRI, we were able to assess stroke and blood-brain barrier damage following the use of atorvastatin from the hyper acute to chronic stages following acute ischemic stroke. Findings support a reduction in lesion volume within the statin group with no significant changes to BBB damage. 

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Peipei Chang¹, Lizhi Xie², and Yanwei Miao^1
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²GE Healthcare, Beijing, China

Keywords: Stroke, Susceptibility, Hemorrhagic transformation

This study was to investigate the effect of prominent vessel sign (PVS) in patients with unilateral subacute infarction on hemorrhagic transformation (HT) and short-term prognosis by using susceptibility-weighted imaging (SWI). It was found that there were no significant differences in the incidence of prominent cortical veins (PCV), prominent medullary veins (PMV), PCV+PMV, SWI-ASPECT score and SWI-DWI mismatch score between two groups. Although higher than the HC group, there was no difference in venous MSV between HT and NHT groups. NIHSS score was negatively correlated with SWI-ASPECT score and DWI-ASPECT score and NIHSS score at discharge was negatively correlated with the proportion of PCV, PCV + PMV and MSV of CV. This study suggesting that PVS had little effect on HT in patients with unilateral subacute infarction, but related to worse short-term clinical status.

Hang Yin¹, junbang feng², fei yu², Meining chen³, lei xue³, wei yu³, and chuanming li^2
1Department of Radiology, Chongqing Emergency Medical Cente, Chongqing, China, ²Chongqing Emergency Medical Center, chongqing, China, ³MR Scientific Marketing, SIEMENS Healthcare, shanghai, China

Keywords: Stroke, Stroke

Shortening MR scan time to diagnosis of acute ischemic stroke helps to perform intravenous thrombolysis more quickly and accurately for patients, thus improving the patients’ prognosis. A rapid stroke protocol was evaluated. With about 10 minutes of scanning, we achieved T1 flash, T2 TSE, T2 flair, high-resolution isotropic DWI, TOF and ASL. This protocol improved the detection rate of cerebral infarct lesions without compromising image quality, which help to make thrombolysis of patients with acute ischemic stroke earlier and more accurate.

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Hongwei Li¹, Min Chu², Lianlian Liu³, He Wang^1,4,5, and Jing Zhao^2
1Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China, ²Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China, ³Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China, ⁴Human Phenome Institute, Fudan University, Shanghai, China, ⁵Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China

Keywords: Stroke, Neuroscience

The mechanism of cognitive impairment following stroke is uncertain. It has been demonstrated that the glymphatic system has an impact on cognitive function, which can be measured by the diffusion weighted image analysis along the perivascular space (DWI-ALPS) index. The purpose of this study was to see whether the DWI-ALPS index was associated with early-onset post-stroke cognitive impairment. Our data revealed that DWI-ALPS index in PSCI group was significantly lower than in non-PSCI group, and it had a good predictive value for PSCI.