Abstract Details

Title Detection of Presymptomatically Latent Lesions Developing into Stroke-Like Episodes by Arterial Spin-Labeling Perfusion MRI in MELAS Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 162

Objective

Background BACKGROUND: SEs in MELAS syndrome occur abruptly and repeatedly, and are a crucial factor determining the prognosis of patients with this syndrome. Although several causal hypotheses of SEs have been proposed, the pathogenesis of SEs in the initial, "presymptomatic" phase remains to be elucidated, and the prediction and prevention of upcoming SEs are great challenges. The ASL method of brain MRI is a promising technique for the non-invasive evaluation of brain perfusion using magnetically labeled blood as an endogenous tracer instead of contrast media.

Design/Methods DESIGN/METHODS: Three patients with MELAS carrying an A-to-G transition at nucleotide position 3243 in their mitochondrial DNA sequentially underwent brain MRI including ASL imaging both at the time of SE onset and in the previous presymptomatic phase of the SE, and the ASL images in each phase were evaluated retrospectively. Two of the 3 patients had previous stroke-like lesions in other brain regions by the time they underwent MRI.

Results RESULTS: ASL perfusion images demonstrated presymptomatically latent lesions as regional hyperperfusion 3 to 7 months before the symptomatic onset of SEs in the 3 MELAS patients. These hyperperfused areas were apparently normal in conventional MR images, such as DWIs and FLAIR images. Fresh stroke-like lesions emerged within and spread throughout these hyperperfused areas in the acute phase of the SEs.

Conclusions CONCLUSIONS: These findings suggest that regional ASL hyperperfusion in the presymptomatic phase precedes the appearance of upcoming stroke-like lesions, and that presymptomatic SEs had already occurred several months before the onset of clinical symptoms. ASL imaging has great potential for detecting presymptomatic stroke-like lesions and predicting the emergence of SEs.

Authors/Disclosures
Masamichi Ikawa (University of Fukui) PRESENTER	No disclosure on file
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Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook)	Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.
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Makoto Yoneda (Univ of Fukui)	No disclosure on file

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