Volume 02 Issue 03-2022
1
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The relationship between the clinical picture of ischemic stroke and magnetic resonance imaging in assessing changes
in the brain substance and cerebral hemodynamics was studied. It was stated that changes in the venous circulation
of the brain are detected on magnetic resonance imaging and magnetic resonance angiography and show a stable
reliable regular relationship with various states of the brain and carry important information about the organization
of its blood supply and identification of the degree and severity of vascular damage to the brain.
KEYWORDS
Clinical picture, ischemic stroke, magnetic resonance, brain substance, cerebral hemodynamics.
INTRODUCTION
At the present time, about 9 million people in the world
suffer from cerebrovascular diseases. The main place
among them is occupied by strokes, which every year
affect from 5.6 to 6.6 million people and claim 4.6
million lives, mortality from cerebrovascular diseases is
second only to mortality from heart diseases and
tumors of all localizations and reaches 11–12% in
economically developed countries [3, 4]. Millions of
people become disabled.The successful development
and introduction of highly informative technologies
into medicine has led to discoveries in the etiology and
pathogenesis of cerebrovascular disorders and a
Research Article
DIAGNOSTIC VALUE OF MAGNETIC RESONANCE IMAGING IN ASSESSING
CHANGES IN THE BRAIN SUBSTANCE AND CEREBRAL HEMODYNAMICS
IN ACUTE CEREBROVASCULAR PATHOLOGY
Submission Date:
February 27, 2022,
Accepted Date:
March 17, 2022,
Published Date:
March 29, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue03-01
N.A. Khodjaeva
Republican Scientific Center for Emergency Medical Care Bukhara Branch, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 03-2022
2
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
revision of approaches to their prevention and
treatment. Science has made significant progress in
diagnosing the pathogenetic variant of stroke due to
the widespread use of MRA and MR angiography [1].
THE MAIN FINDINGS AND RESULTS
In the last decade, interest has grown in the study of
venous cerebral circulation dyscirculation, in the
formation of which an important role is played by
changes in the tone of intracranial veins and
disturbances in the outflow of venous blood from the
cranial cavity caused by various etiological factors [5,
6]. A significant frequency of occurrence of cerebral
venous dyscirculation is also systematically confirmed
by additions to the list of causes of venous circulation
disorders and studies of cerebral hemocirculation in
various diseases of the nervous system and somatic
sphere [2]. It should be remembered that the clinical
picture of cerebral venous dyscirculation is not well
understood and specific, which complicates its timely
diagnosis.
The aim of our study was to study the relationship
between the clinical picture of AI and MRA in assessing
changes in the brain substance and cerebral
hemodynamics.
We examined 110 patients with MRA and clinically
confirmed AI. The distribution of patients by type of AI
is presented in Table 1.
Neurological examination of patients in 86 (78.2%)
patients revealed motor disorders in the form of mild
or moderate right-sided hemiparesis - 60 (54.5%) of
them, left-sided hemiparesis - in 26 (23.6%) patients;
coordinating (77.4%) and sensitive (64.5%) disorders. All
these symptoms were not detected in lacunar AI.
Elements of motor aphasia were observed in 7 (6.4%)
patients, sensory - in 5 (4.5%), mixed aphasia - in 4
(3.6%).
Table 1. Distribution of patients by sex, age and subtype of ischemic stroke.
Stroke subtype
Age
(years)
Men
Women
Total
N
%
n
%
n
%
Atherothrombotic (At)
62,6±3,2
19
17,3
23
20,9
42
38,2
Lacunar (Lacquer)
59,4±2,7
16
14,5
14
12,7
30
27,3
Cardioembolic (Ce)
57,2±3,1
12
10,9
10
9,1
22
20,0
Hemodynamic (Hd)
75,2±3,4
7
6,4
9
8,2
16
14,5
Total
65,9±3,1
54
49,1
56
50,9
110
100,0
MRA was performed on a Siemens Magnetom
Symphony machine equipped with a superconducting
magnetic system with a field strength of 1.5 Tesla.
Tomograms were obtained according to the standard
Volume 02 Issue 03-2022
3
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
method in axial, sagittal and coronal projections using
T2, T1 pulse sequences, FLAIR and DWI programs.
When interpreting MRA of the brain, the presence of
focal, diffuse (leukoareosis) and atrophic changes in
the white matter of the brain was assessed.
When analyzing the study, we identified the following
MRA signs of AI: the absence of a signal of blood
outflow through the vessel in the affected area,
changes in signal intensity in T1 and T2 modes,
compression and/or dislocation of the midline
structures of the brain, and local swelling of the brain
tissue.
The image of the ischemic focus in MRA has a certain
dynamics which is due to a combination of signs of
cerebral dyscirculation and changes in the very
substance of the brain. The earliest MRA sign reflects a
violation of hemodynamics and the state of the lumen
of the vessel (usually the absence of a blood flow
signal), but it manifests itself only in a quarter of all
subjects on the first day. It is often determined with
extensive and large infarct foci with occlusion of large
arteries of the brain. With occlusion of the cortical and
deep branches of the cerebral arteries, this symptom is
usually not detected.
In 36 (32.7%) of the studied patients, MRA revealed an
expansion of the ventricular system and cerebrospinal
fluid spaces of varying severity: mild - in 29 (26.4%)
patients, moderate - in 66 (60%), severe - in 15 (13.6%)
patients.
Local ischemic changes in the substance of the brain on
MRA were observed in 107 (97.3%) patients. In the
majority of patients (102, 92.7%), focal changes in the
form of deep small infarcts of the brain substance were
localized in the area of the white matter of the
semioval centers, in the area of the subcortical ganglia,
the internal capsule, as well as in the structures of the
trunk - in the cerebellum, thalamus, pons,
hippocampus. In 33 (30%) patients, large-focal changes
were combined with medium-sized foci, and in 9 (8.2%)
patients - with several small foci.
A decrease in the density of the white matter of the
brain (leukoareosis) was detected in 97 (88.2%)
patients. Focal changes in the area of the
periventricular white matter were recorded as limited
leukoaraiosis in 30 (27.3%) patients, moderate diffuse
changes in the periventricular white matter were
noted in 14 (14.5%) patients, and pronounced diffuse
changes in the white matter of the subcortical region
were found in 9 (8. 2%) patients.
Ischemic foci in the brain tissue more accurately
demonstrate the prevalence and dynamics of ischemia
and are manifested by a change in the intensity of the
MRA signal and signs of local edema. Local swelling of
the brain tissue was often detected within a period of
up to three days, subsiding in the acute period (up to
21 days); during the rehabilitation period was not
observed in any patient. Local edema was better
visualized in the T1 mode, in most patients (107, 97.3%)
it was detected by the end of the first day of AI.
However, detection of cortical AI foci and stem foci
was more often displayed in T2-mode than in T1-mode.
The dynamics of MRA was manifested in a change in
the signal from heterogeneous to homogeneous and
contouring of the AI focus with a clearer demarcation.
On MRA in the first 12 hours, signal inhomogeneity was
noted in 88 (80%) patients, by 7 days in 50 (45.5%), and
at the time of discharge from the hospital (20-21 days)
- only in 8 (7.3% ) examined (p<0.05).
It was found that in the most acute period of AI, fuzzy
contours of the focus were more common (90
patients, 81.8%). However, by the beginning of the
acute period (7 days), an increase in the number of foci
Volume 02 Issue 03-2022
4
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
with clear contours was noted, and at the time of
discharge from the hospital (20-21 days), the clarity of
the contours of the foci was noted in 102 (92.7%)
patients (p<0.05) . Well-defined foci were found more
often in T2-mode.
Thus, MRA is highly informative in diagnosing foci of
the ischemic process, and early MRA signs of IS are
vascular changes that visualize impaired blood flow
and vascular lumen, along with changes in the
substance of the brain, manifested by a change in the
signal in T2 and local edema in T1 mode.
The sensitivity and accuracy of MRA for diagnosing AI
was about 90%, and the specificity of the method was
100%.
The MR angiography method made it possible to
visualize, without the introduction of a contrast agent,
a multiplanar picture of the vessels of the brain and
neck in all examined patients, to identify the location
(level) of the lesion, to determine the anatomical
deviations of their structure, and to assess the
possibility of collateral blood flow. MR angiography
along with MR tomography should be included in the
protocol of MR examination of patients with AI in the
acute period of the disease.
An analysis of MRA and MR angiography showed that
the most common complication of AI was a volume
effect on various parts of the liquor system, midline
brain structures and stem parts. The severity of this
effect depended on the size and localization of the
infarction focus. Maximum lateral and axial dislocation
was found in extensive brain infarcts. With large
infarction foci in the MCA basin, we observed a mixture
of median brain structures, not to the same extent as
with extensive infarcts. With AI foci in the basins of the
anterior and posterior cerebral arteries, the
displacement of brain structures was visualized as
compression of the corresponding sections of the
lateral ventricles without displacement of the median
hemispheric structures of the brain matter. The volume
effect in medium hemispheric AI, located in the deep
parts of the brain parenchyma, was manifested by
compression of the adjacent parts of the ventricles.
With small-focal cerebral infarctions, the effect of
displacement was absent. We have proven a direct
significant significant relationship between the volume
of damage to the brain substance and the occurrence
of complications (p<0.05).
Based on the data obtained from the study, a regularity
was proved that the presence of an extensive
infarction leads to complications and has an extremely
unfavorable prognosis. Significant criteria for the
severity of AI on MRA are: severe perifocal edema,
detection of leukoareosis, severe internal and external
hydrocephalus. The combination of these features
gives grounds to predict the worst outcome of
ischemic stroke. So, with a large infarct with a
morphologically significant defect, but without the
presence of these three factors, the positive clinical
and neurological dynamics is more pronounced than in
patients with a smaller infarct, but with the presence
of these components.
The most frequent changes in the MRA picture were
found in atherothrombotic and lacunar types of AI. At
the same time, according to MRA and MR angiography,
57 (79.2%) patients with atherothrombotic and lacunar
AI showed asymmetry of the main cerebral veins;
jugular veins and cerebral sinuses were dilated on the
right in 26 (36.1%) patients, on the left - in 31 (43.1%). In
6.9% (5 people) cases, congenital anomalies in the
development of the drainage system of the brain were
stated - in 2 (2.8%) patients - hypoplasia of one of the
transverse sinuses, in 2 (2.8%) patients - aplasia of the
transverse sinus, in 1 (1.4%) patient - hypoplasia of the
Volume 02 Issue 03-2022
5
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
sigmoid sinus. In all patients with anomalies in the
development of the venous sinuses, we noted a
compensatory expansion of the contralateral sinuses.
During MR angiography in the venous phase of
cerebral
circulation
in
the
group
with
atherothrombotic IS, 32 patients (76.2%) and 25 (83.3%)
patients in the group with lacunar AI revealed
structural changes in the cerebral venous system
corresponding to different stages of ischemic damage
brain and having some variability of the anatomical
structure. The cerebral venous bed is characterized by
significant structural resistance to hemodynamic shifts
in stroke due to compensatory capabilities.
The most common forms of damage to extra- and
intracranial vessels in patients of both groups were:
vascular elongation, narrowing of the lumen or
occlusion of the vessel (Table 2).
Table 2. The frequency of occurrence of various forms of vascular lesions
Type of violation
Atherothrombotic AI
Lacunar AI
1 side
2 side
1 side
2 side
Vessel elongation
7
1
5
0
Narrowing of the vessel lumen
21
11
19
8
Vessel occlusion
6
1
2
0
Slight curvature
9
3
7
2
Average curvature
5
2
4
2
Sharp angle bend
1
The frequency of detection of bends of at least one
vessel in patients with AI was 48.6% (35 patients), in 9
(12.5%) patients the bends were bilateral. According to
localization, the initial segment and siphon of the ICA
most often suffered (13 (18.1%) patients).
With a pronounced and prolonged outflow
disturbance along one of the internal jugular veins, the
cross-sectional area of the contralateral internal
jugular
vein
increases
by
3-8
times.
With
hemodynamically significant compression, the cross-
sectional area of other venous collectors also
increases, collaterals and shunts appear, which reach
their maximum development in bilateral lesions. The
lower the level of damage, the less pronounced
compensatory changes.
CONCLUSION
Thus, changes in the venous and arterial circulation of
the brain are detected on MR angiography and show a
regular relationship with various states of the brain and
carry important information about the organization of
its blood supply and identifying the degree and severity
of vascular damage to the brain.
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Russian
Military
Medical
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Volume 02 Issue 03-2022
6
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
03
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
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