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Chao Zhang¹, Jingyun Sha¹, Lulu Cai¹, Houliang Zhao¹, Weiqiang Dou², and Kai Xu^1
1Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China, ²MR Research China, GE Healthcare, Beijing, China

Keywords: Stroke, Diffusion Tensor Imaging, glymphatic system

We evaluated the function of the human glymphatic system (GS) in patients with spontaneous intracerebral haemorrhage (sICH) using diffusion tensor imaging analysis along with the perivascular space (DTI-ALPS). Twenty patients with sICH and 31 healthy controls (HCs) were recruited for analysis. The results showed that DTI-ALPS index on the lesion side was significantly decreased, but not in the contralateral side in sICH or in HCs. And, the decreased DTI-ALPS index was significantly correlated with disease duration. This study confirmed the presence of GS dysfunction only ipsilateral to the lesion, indicating the GS may be a separate system in bilateral hemispheres.

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Chisondi Simba Warioba¹, Mira Liu¹, Sean Foxley¹, Julian Bertini¹, Gregory Christoforidis², and Timothy Carroll^1
1Radiology, University of Chicago, Chicago, IL, United States, ²Mount Carmel, Columbus, OH, United States

Keywords: Stroke, fMRI (resting state)

Through the use of resting state functional MRI, diffusion tensor imaging (DTI), and a unique canine stroke model, our study explored the functional and structural effects of maintaining perfusion pressure as a means of extending the window of opportunity for thrombectomy. In our preliminary results, the employment of flow augmentation indicated a maintenance of functional connectivity, mean T2* signal intensity, and mean diffusivity in the ischemic region. Through this we have shown a potential method of extending the "door-to-needle time" in stroke treatment and possible therapeutic effects of flow augmentation therapy in acute stroke.

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Alexander K. Song^1,2, Spencer L. Waddle³, Randall Sky Jones⁴, Niral J. Patel⁴, Samantha Davis⁴, Chelsea Custer¹, Larry Taylor Davis³, Sumit Pruthi³, Jarrod J. Eisma¹, Megan A. Aumann¹, Lori C. Jordan⁴, and Manus J. Donahue^1
1Neurology, Vanderbilt University Medical Center, Nashville, TN, United States, ²Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States, ³Radiology, Vanderbilt University Medical Center, Nashville, TN, United States, ⁴Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United States

Keywords: Stroke, Stroke

Sickle cell anemia (SCA) patients have elevated cerebral blood flow and flow velocities to partially compensate for reduced blood oxygen content; this phenomenon may result in inefficient oxygen delivery to tissue due to accelerated red cell capillary transit. Pseudo-continuous arterial spin labeling (pCASL) and T₂-relaxation-under-sping-tagging (TRUST) MRI methods were used to assess arterial-to-venous transit artifacts and oxygen metabolism in 150 SCA participants. Patients with diffuse dural sinus hyperintensities on pCASL had 22.7% lower cerebral metabolic rates of oxygen compared to their counterparts; however, values remained within a normal range of 2.91±0.69 ml O₂/100g/min and were not associated with infarct history.

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Ashmita De¹, Jeff Snyder¹, Mahesh Kate², Derek J. Emery³, and Alan H. Wilman^1
1Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada, ²Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada, ³Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

Keywords: Stroke, Brain

T2 mapping can provide a route to monitor both iron changes in hemorrhage and water changes in ischemic stroke. Our aim is to investigate the value of T2 mapping from standard proton density and T2-weighted fast spin echo images for hemorrhagic and ischemic stroke. Rapid T2 maps using sequence modeling were reconstructed and compared with susceptibility and apparent diffusion coefficient for 13 hemorrhages and 14 ischemic stroke lesions respectively. Quantitative T2 is highly correlated with susceptibility for hemorrhage and diffusion for ischemic stroke, providing complementary measurements of water and iron changes.

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Bin Bo¹, Tianyao Wang², Ziyu Meng¹, Yibo Zhao^3,4, Yudu Li^3,5, Rong Guo^3,6, Wen Jin^3,4, Xin Yu⁷, Zhi-Pei Liang^3,4, and Yao Li^1
1School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China, ²Radiology Department, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China, ³Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States, ⁴Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States, ⁵National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, United States, ⁶Siemens Medical Solutions USA, Inc., Urbana, IL, United States, ⁷Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States

Keywords: Stroke, Spectroscopy

Imaging lactic acidosis is of significance for injury assessment in acute stroke. In this study, we investigated the progression of lactate, along with the concomitant changes in N-acetylaspartate and creatine concentrations, and its relationship to infarct growth using high-resolution MRSI data acquired from a longitudinal cohort of 42 ischemic stroke patients. The results showed that the progression in lactate level was predictive of infarct growth volume from acute to subacute stroke. Our study might provide a useful biomarker for lactic acidosis and tissue injury assessment in ischemic stroke.

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

Keywords: Stroke, fMRI, ischemic, cognitive, dynamic

This study aimed to explore the temporal dynamic change patterns and the mechanisms of verbal memory deficit in chronic subcortical stroke patients with motor pathway based on the static and dynamic amplitude of low-frequency fluctuations. A total of 136 patients and 88 normal controls were included in the study. We found verbal memory deficits in the patients of chronic subcortical stroke involving the motor pathway, especially in patients with partial recovery. Moreover, subcortical stroke-induced functional deficits may not only occur in the motor system but also in the cognitive functional system.

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Peirong Jiang¹, Xiuzhu Xu¹, Yanping Zheng¹, Jialin Chen², Peng Wu³, and Yunjing Xue^1
1Radiology, Fujian Medical University Union Hospital, Fuzhou, China, ²Neurology, Fujian Medical University Union Hospital, Fuzhou, China, ³Philips Healthcare, Shanghai, China

Keywords: Stroke, Ischemia, Neurologic deficits

This study explores the value of quantitative parameters derived from diffusion spectrum imaging (DSI) in distinguishing between mild (NIHSS score ≤ 5) and severe (NIHSS score > 5) neurologic deficits at discharge in DWI positive acute ischemic stroke (AIS) patients. The method is to compare conventional diffusion and DSI parameters of acute infarction between the two groups. Our research shows DKI_AK, DKI_MKT, DKI_RK, MAP_RTPP and NODDI_ICVF can predict poor neural function outcome at discharge, with NODDI_ICVF demonstrates the highest diagnostic performance. DSI is a promising approach in detecting microstructural brain tissue changes in acute infarction lesion.

Chaofan Sui¹, Qihao Zhang², Junghun Cho², Linfeng Yang³, Tao Chen³, Bin Guo³, Kelly M. Gillen², Jing Li⁴, Lingfei Guo¹, and Yi Wang^2
1Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China, ²Department of Radiology, Weill Cornell Medical College, New York, NY, United States, ³Department of Radiology, Jinan Maternal and Child Care Hospital, Jinan, China, ⁴Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

Keywords: Stroke, Hypertension

The objective of this study was to analyze the different brain oxygen metabolism statuses in preeclampsia. Furthermore, we also investigated the influencing factors that affect cerebral oxygen metabolism in preeclampsia. Forty-nine preeclampsia patients, forty nonpregnant healthy controls (NPHCs) and twenty-two pregnant healthy controls (PHCs) were included in this study. Brain OEF values were computed using quantitative susceptibility mapping (QSM) plus quantitative blood oxygen level‐dependent magnitude-based OEF mapping (QSM+qBOLD, or QQ). Voxel-based morphometry (VBM) was applied to investigate the differences of OEF values in brain regions among groups.

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Karl-Olof Lövblad^1,2, Daniela Dumitriu LaGrange², Lijing Xin³, Philippe Reymond², Seàn Fitzgerald⁴, Karen M. Doyle^4,5, Paolo Machi^1,2, Maria Isabel Vargas^1,2, François Lazeyras^2,3, and Isabel Wanke^6,7,8
1Division of Diagnostic and Interventional Neuroradiology, HUG Geneva University Hospitals, Geneva, Switzerland, ²Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland, ³Ecole Polytechnique Fédérale de Lausanne (EPFL), Center for Biomedical Imaging (CIBM), Lausanne, Switzerland, ⁴Department of Physiology, University of Galway, Galway, Ireland, ⁵CURAM, Sciene Foundation Ireland (SFI) Centre for Research in Medical Devices, University of Galway, Galway, Ireland, ⁶Division of Neuroradiology, Klinik Hirslanden, Zurich, Switzerland, ⁷Swiss Neuroradiology Institute, Zurich, Switzerland, ⁸Division of Neuroradiology, University of Essen, Essen, Germany

Keywords: Stroke, Stroke

In acute ischemic stroke, the composition of the clot occluding the arteries is associated with the underlying pathophysiology and with the response to treatment. Innovative MRI sequences aim to improve the ability to recognize clot composition from neuroimaging signs. Using ultra-high field MR imaging of clot analogs, we demonstrate the ability of R2* map to distinguish between red blood cells-rich and fibrin-rich compositions. This technique can also be used for the volumetric analysis of formalin fixed clots. Further studies with intermediate clot compositions and improved phantoms will reveal the full potential of MRI sequences for depicting clot composition.

Ruijing Xin¹, Maoxue Wang¹, and Bing Zhang^1
1Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

Keywords: Stroke, Atherosclerosis, High-risk plaque

Carotid HRP is one of the major sources of ischemic stroke. Recent studies have focused on identifying characteristics of HRP which is defined as lesion with IPH, FCR, or LRNC. We compared the plaque characteristics of patients with bilateral carotid HRPs between patients with recurrent stroke and those without recurrent stroke using MR vessel wall imaging. We determined the association between HRP plaque features and recurrent stroke in patients with bilateral carotid HRPs. We found that those with larger plaque burden, more juxta luminal IPH and/or thrombus, and juxta luminal calcification in HRPs were more likely to have recurrent stroke.

Yu Guo¹, Weiqiang Dou², Huimin Mao¹, and Xinyi Wang^1
1Radiology, The First Affiliated Hospital of Shandong First Medical University＆Shandong Provincial Qianfoshan Hospital, Jinan, China, ²MR Research, GE Healthcare, Beijing, China

Keywords: Stroke, Perfusion

The main purpose was to explore iron alterations in gray matter (GM) nucleus of patients with unilateral middle cerebral artery (MCA) stenosis or occlusion with varied cerebral perfusion states using quantitative susceptibility mapping (QSM). Sixty-one patients with unilateral MCA stenosis or occlusion were divided into three groups based on different cerebral perfusion patterns and examined with QSM. Iron-related susceptibility of GM nucleus subregions were assessed. The results showed that iron deposition in bilateral putamen and globus pallidus at the lesion side significantly increased in patients with extensive impaired but not hypo- or normal cerebral perfusion.

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Mihika Gangolli^1,2, Alexander Kharlamov³, David Y. Chung⁴, Fernando Boada⁵, Victor E. Yushmanov³, Dzung L. Pham^1,6, John A. Butman^1,7, and Stephen C. Jones^3,8
1Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States, ²The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States, ³Allegheny-Singer Research Institute, Pittsburgh, PA, United States, ⁴Radiology, Harvard Medical School, Charlestown, MA, United States, ⁵Radiology, Stanford University School of Medicine, Palo Alto, CA, United States, ⁶Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, United States, ⁷Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States, ⁸CerebroScope, Pittsburgh, PA, United States

Keywords: Stroke, Diffusion/other diffusion imaging techniques, Peri-infarct depolarization, dynamic diffusion MRI

An automated analysis pipeline was developed to detect and analyze the trajectories of dynamic diffusion abnormalities (DDAs) in a rat model of severe ischemic injury. DDAs were detected in both hemispheres of the brain and perilesional DDAs propagated along the infarct boundary. Infarct volume, quantified using apparent diffusion coefficient (ADC), increased during the recording period concomitantly with detected DDAs. Our approach could provide the means to explore the causal relationship between DDAs hypothesized to correspond with peri-infarct depolarizations and secondary expansion of infarcted tissue.

Lingling Wang¹, Beibei Sun¹, Maysam Orouskhani², Mahmud Mossa-Basha², Jianrong Xu¹, Yan Zhou¹, Chengcheng Zhu², and Huilin Zhao^1
1Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ²University of Washington, Seattle, United States, Seattle, WA, United States

Keywords: Stroke, Atherosclerosis, Calcification

Intracranial atherosclerotic plaque is a major cause of stroke. Both CTA and vessel wall magnetic resonance imaging (VW-MRI) can identify high risk plaque features. We aim to investigate the intracranial atherosclerotic plaque features associated with recurrent stroke using a multi-modality imaging approach by combining CTA and whole brain VW-MR. We found that higher calcium burden quantified by volume and Agatston score of intracranial arteries, as well as whole-brain plaque number and culprit plaque burden were independently associated with recurrent acute stroke.

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Wenjia Peng¹, Haiyan Zhao¹, Xuefeng Zhang¹, Luguang Chen¹, Hao Li², Shuo Wang², and Jianping Lu^1
1The First Affiliated Hospital of Naval Medical University, Shanghai, China, ²Fudan University, Shanghai, China

Keywords: Stroke, Stroke, vessel wall imaging

Image quality control is a prerequisite for quantitative image analysis. We develop a convolutional neural network-based model for assessing the image quality of intracranial vessel wall MRI. Experimental results show that the model prediction is in good agreement with a senior radiologist, with a Cohen’s Kappa of 0.689. The model demonstrates real-time evaluation speed which is 500 times faster than the radiologist. It has the potential to be used in performing quality control on historical data for research purposes, and also can be used to examine the image quality immediately after the clinical MRI scan.

Ashu Bhasin¹, Rahul Sharma¹, MV Padma Srivastava¹, and S Senthil Kumaran^2
1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India, ²Department of NMR, All India Institute of Medical Sciences, New Delhi, India

Keywords: Stroke, fMRI (task based)

Non invasive brain stimulation holds great promise in post stroke recovery in upper limb hand function and inducing neural plasticity. Transcranial direct current stimulation (tDCS) enables the alteration of cortical excitability by passing direct currents causing hypo or hyperpolarization of neuronal resting membrane potentials. Bi-cephalic tDCS with anode applied on the affected cortex especially M1 and cathode over the non-affected cortex has been used to normalize excitatory and inhibitory corticospinal networks.

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Qi Duan¹, Jinhao Lyu¹, Caohui Duan¹, Xiangbing Bian¹, Jianxun Qu², and Xin Lou^1
1Chinese PLA General Hospital, Beijing, China, ²MR Collaboration, Siemens Healthineers Ltd., Beijing, China

Keywords: Stroke, High-Field MRI, Suzuki staging system

Moyamoya disease (MMD) is an uncommon chronic cerebrovascular disease and a leading cause of stroke in pediatric and young patients. Suzuki staging system based on conventional digital subtraction angiography (DSA) is a useful and important index in clinical. However, DSA is invasive and unnecessary in some situations. 7T TOF-MRA enables the visualization of the "puff of smoke" collateral network in MMD compared to 1.5T and 3T. We tried to grade the Suzuki staging system by using 7T TOF-MRA in MMD patients. Our results indicated that 7T TOF-MRA showed excellent performance as DSA on grading the Suzuki staging system in MMD.

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Xiaodong Zhang¹, Yuguang Meng¹, and Chun-Xia Li^1
1Emory University, Atlanta, GA, United States

Keywords: Stroke, Brain, Oxygen extraction fraction

Oxygen extraction fraction (OEF) has been suggested to be an effective measure to assess the oxygen metabolism and viability of tissue at risk. The preliminary results in a monkey model of stroke demonstrated progressive OEF reduction in both grey matter and white matter after pMCAO, in agreement with the neuron loss and fiber denegation as indicated by diffusion MRI indices following stroke. The findings suggest QSM derived OEF could provide additional information about the oxygen metabolism of the tissue and may be used to assess the ischemia-induced damage of the brain during acute stroke.

Eleni Demetriou^1,2, Valerie Taylor³, Mohamed Tachrount⁴, Kimmo Jokivarsi ⁵, Olli Grohn⁵, Rolf Jager⁶, Karin Shmueli⁷, and Xavier Golay^8
1Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, United States, ²Brain repair and Rehabilitation, Institute of Neurology, Dallas, TX, United States, ³University College of London, Center for Advanced Biomedical Imaging, London, United Kingdom, ⁴Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, London, United Kingdom, ⁵A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland, Kuopio, Finland, ⁶Institute of Neurology, Brain repair and rehabilitation, London, United Kingdom, ⁷Department of Medical Physics & Bioengineering, University College London, UK, London, United Kingdom, ⁸Brain repair and rehabilitation, Institute of Neurology, London, United Kingdom

Keywords: Stroke, Ischemia, ischemic penumbra

Here, our goal was to visualise dynamic pH changes in a rat model of MCAO and their relation to other imaging techniques for identifying the penumbra zone which is used to guide therapeutic intervention.

Yue Ma¹, Yueluan Jiang², Dan Tong¹, Zechen Yu³, and Xinpeng Liu^1
1Radiology, First Hospital of Jilin University, Changchun of Jilin province, China, ²MR Scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd., Beijing, China, ³Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Changchun of Jilin province, China

Keywords: Stroke, Blood vessels

Evaluation of hemodynamic and geometric changes of intracranial atherosclerosis and follow-up is of great clinical significance. A comprehensive quantification of the whole collateral recruitment in the circle of Willis (CW) is needed. In this work, we combined High-resolution CS TOF-MRA and 4D Flow MRI to investigate the situation of collateral recruitment. We were able to demonstrate a new way to visual and quantify the cerebrovascular impact of a significant intracranial stenosis and the compensatory mechanism of the collaterals.

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Peipei Chang¹, xinyue liang², Yanwei Miao¹, and yongming dai^3
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²MR Collaboration,Central Research Institute, United Imaging Healthcare, Shanghai, China, ³MR Collaboration,Central Research Institute, United Imaging Healthcare, shanghai, China

Keywords: Stroke, Ischemia, T2 Star

Multiple parametric (MTP) is a novel quantitative MRI technique that allows the generation of quantitative maps as well as synthetic weightings from a single acquisition. Preliminary results show that MTP synthetic sequence can effectively distinguish infarcted brain from normal tissue with a good diagnostic performance. MTP imaging offers the potential to create a standardized brain imaging protocol providing multiple types of quantitative tissue property information and qualitative information in just a few minutes. The aim of this study is to evaluate the potential of MTP in the mapping-based identification of acute ischemic stroke.