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H. Jeong, B. Kim, M. Yang, Moon‐Ku Han, H. Bae (2015)
Neuroimaging Markers for Early Neurologic Deterioration in Single Small Subcortical InfarctionStroke, 46
Yuki Shinohara, A. Kato, Keita Kuya, K. Okuda, Makoto Sakamoto, H. Kowa, T. Ogawa (2017)
Perfusion MR Imaging Using a 3D Pulsed Continuous Arterial Spin-Labeling Method for Acute Cerebral Infarction Classified as Branch Atheromatous Disease Involving the Lenticulostriate Artery TerritoryAmerican Journal of Neuroradiology, 38
LETTERS Regarding“PerfusionMRImagingUsinga3DPulsed ContinuousArterialSpin-LabelingMethodforAcuteCerebral InfarctionClassifiedasBranchAtheromatousDiseaseInvolving theLenticulostriateArteryTerritory” e read the article on the use of 3D pulsed continuous arte- baseline DWI lesion volume may have collinearity. If that is the Wrial spin-labeling (ASL) MR imaging for acute infarction case, the authors should conduct multivariable regression analysis associated with presumed branch atheromatous disease (BAD) by to determine which one is independently associated with baseline Shinohara et al with great interest. The authors suggested that the NIHSS score. Second, it seems that the baseline NIHSS scores of baseline NIHSS score was significantly correlated with the asym- 23 patients are not normally distributed (based on the Shapiro- metry index of CBF in the contralateral cerebellar hemisphere Wilk test). Thus, nonparametric linear regression and Spearman (crossed cerebellar diaschisis, AI )(r 0.515) and DWI lesion rank correlation are rather appropriate. Third, the prevalence of CCD volume (r 0.664), whereas it was not with the asymmetry index END and clinical outcomes (such as discharge NIHSS scores or of CBF in the affected area (DWI lesion). The point of this study mRS at 3 months) should be compared between the patients with would be that even acute cerebral infarction by presumed BAD higher AI and those with lower value to confirm the clinical CCD can show crossed cerebellar diaschisis on ASL MR imaging, which implication of obtaining ASL MR imaging in these patients. The is correlated with the degree of neurologic severity. Their obser- authors only showed that the AI detected by ASL MR imaging CCD vations will draw the interest of the American Journal of Neurora- is correlated with the baseline NIHSS score in this study. Finally, if diology readers. As the authors pointed out, however, the clinical they obtained ASL MR imaging in patients with non-BAD acute implication of the so-called BAD-type DWI lesions, which is usu- infarction, it would be better to include them for further analysis ally determined by their location and size, is that they are strongly to determine whether they are different from those with BAD- associated with early neurologic deterioration (END). A recent type acute infarction in terms of prediction of END or baseline study with 587 patients showed that BAD-type DWI lesions and neurologic severity. relevant artery stenosis can predict END, whereas the baseline NIHSS score cannot. Thus, we already know that larger or longer REFERENCES DWI lesions may be a red flag for END, particularly when they are 1. Shinohara Y, Kato A, Kuya K, et al. Perfusion MR imaging using a 3D associated with relevant artery stenosis. In this circumstance, it pulsed continuous arterial spin-labeling method for acute cerebral would be better to provide firm evidence for obtaining ASL MR infarction classified as branch atheromatous disease involving the lenticulostriate artery territory. AJNR Am J Neuroradiol 2017 Jun 8. imaging by assessing its utility for the prediction of END. We also [Epub ahead of print] CrossRef Medline would like to comment on the methods in this study. First, the 2. Jeong HG, Kim BJ, Yang MH, et al. Neuroimaging markers for early correlation between the AI and the baseline DWI lesion vol- CCD neurologic deterioration in single small subcortical infarction. ume should be tested because it is expected that baseline DWI Stroke 2015;46:687–91 CrossRef Medline lesion volumes correlate well with baseline NIHSS scores, and X D.H. Shin Department of Neurology larger DWI lesions have CCD more frequently. Thus, AI and CCD X E.Y. Kim Department of Radiology Gachon University Gil Medical Center http://dx.doi.org/10.3174/ajnr.A5356 Incheon, South Korea AJNR Am J Neuroradiol 38:E103 Dec 2017 www.ajnr.org E103
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: Dec 1, 2017
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