Imaging Neurovascular Uncoupling in Acute Migraine with Aura with Susceptibility Weighted Imaging

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ORIGINAL ARTICLE

Imaging Neurovascular Uncoupling in Acute Migraine with Aura with Susceptibility Weighted Imaging Frauke Kellner-Weldon1,3 · Marina Jossen1 · Philipe S. Breiding1 · Lorenz Grunder1 · Christoph Schankin2 · Adrian Scutelnic2 · Urs Fischer2 · Raphaela Muri1 · Manuela Pastore-Wapp1 · Roland Wiest1 · Marwan El-Koussy1 Received: 12 May 2020 / Accepted: 2 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Purpose Migraine with aura (MwA) in the emergency setting is common and sometimes difficult to distinguish from mimicking conditions. Susceptibility weighted imaging (SWI), a magnet resonance (MR) technique is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation. Our study aimed at evaluating the frequency of regions of prominent focal veins (PFV) on SWI in the acute phase. Methods Between 2011 and 2018 we evaluated symptoms and MR imaging of adult patients with acute MwA attacks (< 5 days after onset of symptoms). Abnormal imaging was visually scored in 12 ROIs on both hemispheres distributed on 3 slices. The score ranged from 0 to 3. Results In all, 638 patients (436 female) mean age 37.39 years (18–89 ± 14.13) were included. Susceptibility weighted imaging was abnormal in 18.8% of patients. The inferior and posterior medial temporal lobe and the occipital lobe were most often affected. Susceptibility weighted imaging was more likely abnormal when MR was performed within 24 hours with an average around 5 hours after symptom onset. The side of aura symptoms and hemispheric imaging alteration in patients with abnormal SWI was highly significant (p < 0.001). Conclusion In the acute episode of MwA, SWI imaging can show a combination of increased deoxygenation. The results may indicate linking PFV to MwA.

Keywords Migraine disorders · Imaging techniques · Deoxygenated hemoglobin · Temporal lobe · Magnetic resonance imaging

Introduction

Data from this study were orally presented at the ASNR in Boston 2019 by Frauke Kellner-Weldon. The current manuscript has not been published in whole or in part, and is not under consideration by another journal.  Frauke Kellner-Weldon

[email protected] 1

Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

2

Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

3

Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

Susceptibility weighted imaging (SWI) is a magnet resonance (MR) technique that is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation [1, 2]. The SWI technique is becoming increasingly available and has moved into routine clinical practice in the last 10 years. Migraine with aura (MwA) may present with acute deficits, mimicking an acute ischemic stroke. Thus, in the