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Acute ischemic stroke with ICA and MCA occlusion

Case Study
Savatovsky, Julien, M.D. Fondation Ophtalmologique Adolphe de Rothschild • France

Patient history

Patient is a 67-year-old female with acute onset of left hemiplegia 1 hour and 35 minutes before the MRI exam, and known contraindication of IV thombolytic therapy. NIH stroke scale = 10. She underwent an MR examination at Foundation Rothschild, Paris, France.

MR examination

The examination was performed on Ingenia 3.0T using a 32-channel dS Head coil. The stroke protocol that was performed included diffusion, FLAIR, fast susceptibility imaging and MR angiography.

Total acquisition time (including SmartBrain) was 7:21 min.

Images

Click on an image to enlarge.
DWI b2000 Voxels 1.25 x 1.80 x 5 mm
Scan time 0:46 min.ADC map
DWI b2000
ADC map
Voxels 1.25 x 1.80 x 5 mm Scan time 0:46 min.
3D FLAIR axial reformat Voxels 1.2 x 1.2 x 1.2 mm<br>
Scan time 1:45 min.<br>
<br>T2 FFE Voxels 1.2 x 1.5 x 5 mm<br>
Scan time 0:31 min. <br>
<br>
3D FLAIR axial reformat
T2 FFE
Voxels 1.2 x 1.2 x 1.2 mm
Scan time 1:45 min.

Voxels 1.2 x 1.5 x 5 mm
Scan time 0:31 min.

MRA (TOF) Voxels 0.5 x 0.65 x 0.65 mm<br>
Scan time 2:23 min. <br>
<br>MRA Voxels 0.5 x 0.5 x 0.5 mm<br>
Scan time 1:06 min. <br>
<br>
MRA (TOF)
MRA
Voxels 0.5 x 0.65 x 0.65 mm
Scan time 2:23 min.

Voxels 0.5 x 0.5 x 0.5 mm
Scan time 1:06 min.

In the right deep MCA territory high signal is seen on the diffusion weighted images (b2000) with low ADC. No obvious abnormality (except subtle asymmetry of the right putamen) is seen on the FLAIR images rules out differential diagnoses and subacute stroke. No hermatoma or blood products are seen on T2-weighted FFE.

 

Time-of-flight MR angiography suggests right carotid and proximal MCA occlusion. On MRA of the supra-aortic vessels and cerebral arteries a right internal carotid bulbar occlusion is seen. Note that right MCA distal branches are visible from cortical collaterals and therefore that thrombus length can be estimated, unlike with the TOF sequence. The diagnosis is acute right deep MCA territory ischemic stroke associated with right carotid and MCA occlusion.

Clinical impact of using Ingenia 3.0T

A stroke exam benefits from the fast imaging capacities of the system. The mobile docking table helps to speed up patient installation in an emergency setting. Our comprehensive but short stroke protocol allows the evaluation of both ischemic core extent and arterial clot. Simultaneous assessment of the supra-aortic vessels provides a “roadmap” for neuro-interventionalists and can help reducing the procedure time.

Related reading:



Results from case studies are not predictive of results in other cases. Results in other cases may vary.


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Jan 20, 2015

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Case Study
Ingenia 3.0T
Brain, dS HeadNeck, dStream, mra, Neuro, stroke, Vascular
 

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