Comparing perfusion data of CE-MRI, SWI and CTA with MR perfusion in stroke

Background: To evaluate the perfusion status of patients with acute stroke, different imaging tools are used depending on condition. CT-CT Angiography and MRI are indispensable imaging tools to diagnose and manage stroke patients. Susceptibility-weighted imaging (SWI) also has been used lately to evaluate vascular structures and consequences of stroke in brain. We aimed to compare CE-MRI, SWI, and CTA with DSC-MRP in terms of perfusion. Methods: Ipsilateral leptomeningeal-pial collateralization (LPC) on CE-MRI was correlated with increased CBV (p<0,001), decreased CBF (p=0,026), prolonged MTT and TTP (p=0,001 and p=0,003). LPC was observed more often in cases with infarct zones with penumbra compared to those without penumbra (p=0,024). Parenchymal enhancement (PE) was positively correlated with prolonged MTT and TTP (p=0,015 and p=0,031). Moreover, there was a positive relationship between PE and increased penumbra ratio over the infarct core (p=0,037). Results: Ipsilateral prominent vessel sign (PVS) was associated with increased CBV (p=0,004) and decreased CBF (p=0,002). No relationship was found between collateralization grading on CTA and perfusion metrics or penumbra ratio. Conclusion: ipsilateral PVS can be a measure of CBV and CBF. LPC on CE-MRI can be a sign of an increase in CBV. PE can show larger penumbra. It is the first in the literature showing the relationship of PE with perfusion deficit. In the light of these findings, we can suggest in case of unavailability of MRP, CE-MRI with SWI can be used to evaluate perfusion status.