Förster A, Wenz H, Böhme J, Groden C, Alonso A
Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
Clin Neuroradiol. 2020 Jun;30(2):221-228. doi: 10.1007/s00062-018-0754-5. Epub 2018 Dec 28.
Gadolinium leakage in ocular structures (GLOS) on fluid-attenuated inversion recovery images (FLAIR) is a novel imaging marker in acute ischemic stroke. The present study sought to investigate the frequency and pattern of blood-retina barrier impairment in acute ischemic stroke due to internal carotid artery (ICA) stenosis or occlusion as demonstrated by GLOS.
From a magnetic resonance imaging (MRI) report database patients were identified with acute ischemic stroke due to ICA stenosis/occlusion who underwent repeated MRI with intravenous contrast agent administration and FLAIR and MR angiography (MRA). On FLAIR the presence of GLOS was noted in the vitreous body.
Overall 51 patients with a median age of 70 years (interquartile range, IQR 63-77 years) were included. Of these, 22 (43.1%) patients had an ICA stenosis and 29 (56.9%) an ICA occlusion. On contrast-enhanced FLAIR, GLOS was observed in 29 (56.9%) patients: in 7 (13.7%) unilateral, in 15 (68.2%) bilateral asymmetrical and in 7 (31.8%) bilateral symmetrical. In unilateral asymmetrical GLOS, more pronounced enhancement was always found ipsilateral to ICA stenosis/occlusion. In 4 (5.9%) patients with asymmetrical GLOS a pre-existing signal increase in the vitreous body was found on native FLAIR. The presence of GLOS was associated with an impaired collateralization through the circle of Willis (p < 0.001) and external carotid artery branches (p = 0.03).
In patients with ischemic stroke due to ICA stenosis/occlusion, GLOS is frequent, commonly unilateral or bilateral asymmetrical, and in some patients associated with pre-existing ocular signal abnormalities. An insufficient collateralization may contribute to the development of unilateral/asymmetrical GLOS.
液体衰减反转恢复序列（FLAIR）图像上眼部结构钆渗漏（GLOS）是急性缺血性卒中一种新的影像学标志物。本研究旨在探讨经GLOS证实的因颈内动脉（ICA）狭窄或闭塞所致急性缺血性卒中血视网膜屏障损害的频率和模式。
从磁共振成像（MRI）报告数据库中识别出因ICA狭窄/闭塞导致急性缺血性卒中且接受了静脉注射对比剂、FLAIR序列和磁共振血管造影（MRA）的重复MRI检查的患者。在FLAIR序列上观察玻璃体中GLOS的存在情况。
共纳入51例患者，中位年龄70岁（四分位间距，IQR 63 - 77岁）。其中，22例（43.1%）患者存在ICA狭窄，29例（56.9%）存在ICA闭塞。在增强FLAIR序列上，29例（56.9%）患者观察到GLOS：7例（13.7%）为单侧，15例（68.2%）为双侧不对称，7例（31.8%）为双侧对称。在单侧不对称GLOS中，总是在ICA狭窄/闭塞同侧发现更明显的强化。在4例（5.9%）不对称GLOS患者的原始FLAIR序列上发现玻璃体中已有信号增强。GLOS的存在与通过Willis环的侧支循环受损（p < 0.001）和颈外动脉分支（p = 0.03）有关。
在因ICA狭窄/闭塞导致缺血性卒中的患者中，GLOS很常见，通常为单侧或双侧不对称，且在一些患者中与既往存在的眼部信号异常有关。侧支循环不足可能导致单侧/不对称GLOS的发生。
