Clinical Usefulness of Magnetic Resonance Angiography in Patients with Cerebellar and/or Brainstem Infarction

J Korean Neurol Assoc > Volume 14(1); 1996 > Article

Journal of the Korean Neurological Association 1996;14(1): 46-52.

소뇌와 뇌간의 경색환자에서 자기공명 혈관 촬영술의 임상적유용성

김형철, 송홍기, 이병철

한림대학교 의과대학 신경과학교실

Clinical Usefulness of Magnetic Resonance Angiography in Patients with Cerebellar and/or Brainstem Infarction

Hyoung-Cheol Kim, M.D., Hong-Ki Song, M.D., Byung-Chul Lee, M.D.

Departmnt of Neurology, College of Medicine, Hallym University

Abstract

Background & Objectives : Magnetic resonance angiography is helpful noninvasive evaluation of intracranial arteries and, in some patients, may spare invasive angiography which has potentially serious complication. However, it's diagnostic value in vertebrobasilar artery disease has not yet been evaluated. Methods : MRA and axial brain MRI of 47 patients with acute cerebellar and/or brainstem ischemia, 26 patients with middle cerebral artery territory infarction, and 40 age matched normal controls were reviewed. Patients wit potential risks of cardiac embolization were excluded. MR Angiography was performed by three dimensional time-of-flight gradient-echo technique. Th diagnosis of vessel stenosis was made only when the lumen diameter was reduced by less than 50% on 3-D images to avoid overestimation of MR angiography. Results : Forty-seven patients had cerebellar and/or brainstem infarction: with signal hyperintensities in T2-weighted MRI sequences. Pons was the most common infarcted site(28/47) , followed by medulla (17/47) , and cerebellum (11/47) . The sensitivity of MR angiography in detecting vascular occlusive lesions of vertebrobasilar artery was 57.5% (28/47) in cerebellar and/or brainstem infarction patients, while 7 of 26 (26.9%) in middle cerebral artery territory infarction, and 2 of 40 (5%) in age matched control subjects showed occlusion or stenosis. MR angiography detected vascular occlusive lesions more frequently on vertebral arteries (25/47, 53.2%) than basilar artery (13/47, 27.7%) . And occlusive or stenotic lesions of vertebral arteries were ipsilateral to ischemic lesion sites in 12 of 17 patients(70.6%), There was no difference between deep small lacunar stroke and perforator occlusion in pons. Absence of flow void on axial T2W imaging was seen only in 9 of 47 patients (19.1%) . Conclusions : The results in this present study suggest that MR angiography is moderately sensitive diagnostic tool in vertebrobasilar occlusive disease although it has limitation in detection of smaller branches occlusion. Except vertebral arteries occlusion, absence of flow void in axial MR imaging is not a reliable findings.