Hemorrhagic Risk of Recent Silent Cerebral Infarct on Prethrombolysis MR Imaging in Acute Stroke

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Fig 1.
Three different patterns of RSCIs defined on MR imaging. A, “Gad+/DWI+” indicates area enhanced on postgadolinium T1WI imaging and in hypersignal intensity on DWI. B, “Gad+/DWI−” is the area enhanced on postgadolinium T1WI imaging but not in hypersignal on DWI. C, “Gad−/DWI+” is the area unenhanced on postgadolinium T1WI but in hypersignal intensity on DWI. GAD indicates gadolinium.

Table 1:

Characteristics of 10 patients with RSCI infarct

No.	Age (yr)	Thromb. IA/IV	Stroke Etiology^{^a}	Infarct Territory	Occluded Vessel	HT^{^b}	MR Imaging Characteristics of Qualifying Lesions (RSCI)					Location^{^c}
No.	Age (yr)	Thromb. IA/IV	Stroke Etiology^{^a}	Infarct Territory	Occluded Vessel	HT^{^b}	Pattern Type	ADC	N RSCI	Hypo-GRE	Max. Diam. (mm)	Location^{^c}
1	63	IV	Undetermined	R Carot.	M2	HI-1	Gad +/DWI-	N	1	No	41	Cortical/same arterial territory
2	63	IA	LV Dis.	R Carot.	M1	–	Gad−/DWI+	D	1	No	5	Cortical/same arterial territory
3	77	IA	Other	R Carot.	IC	PH-2	Gad−/DWI+	D	2	No	5	Cortical/same arterial territory
4	42	IA	Other	R Carot.	M1	PH-1	Gad+/DWI+	D	4	No	15	Multiple territories
5	63	IV	LV Dis.	L Carot.	CC+M1	HI-2	Gad−/DWI+	D	1	No	7	Cortical/same arterial territory
6	74	IV + MT	LV Dis.	R Carot.	CC+M1	PH-1	Gad+/DWI+	D	3	No	15	Cortical/same arterial territory
7	49	IV	Undetermined	L Carot.	CC+M1	–	Gad+/DWI−	N	1	No	11	Cortical/same arterial territory
8	36	IA	Other	BA	BA	–	Gad−/DWI+	D	1	No	23	Cortical/same arterial territory
9	40	IA	Cardioembolic	L Carot.	M1	–	Gad+/DWI−	N	2	No	13	Cortical/same arterial territory
10	78	IV	LV Dis.	L Carot.	CC+M1	HI-2	Gad+/DWI−	N	1	Yes	15	Cortical/other arterial territory

Note:—IA indicates intra-arterial; Thromb., thrombolysis; HT, hemorrhagic transformation; N, normal ADC compared with the contralateral side; D, decreased ADC compared with contralateral side; N RSCI, number of areas of RSCI per patient; hypo-GRE, hypointensity on T2 gradient-echo-T2WI within the RSCI area; Max. Diam., maximum diameter of RSCI in millimeters measured on axial FLAIR; LV Dis., large-vessel disease etiology; Other, other etiology; R Carot., right internal carotid artery; L Carot., left internal carotid artery; M2, second segment of the middle cerebral artery; M1, first segment of the middle cerebral artery; IC, intracranial internal carotid artery; CC, cervical internal carotid artery; BA, basilar artery; MT, mechanical thrombectomy; Gad+, gadolinium enhancement on T1WI; Gad−, lack of gadolium enhancement on T1WI.
↵a According to the TOAST classification, patients younger than 56 years with associated patent foramen ovale and atrial septum aneurysm (patient 9) were classified under “cardioembolic.” “Other” etiology was myeloproliferative-disorder-associated coagulopathy in patient 3; paraneaoplastic coagulopathy in patient 4; and vertebral artery dissection in patient 8.
↵b According to the ECASS definition.⁴
↵c Location of the RSCI was compared with the acute infarct arterial territory.