From the Guidelines
T2 Hyperintensity and Brainstem Infarction
Yes, T2 hyperintensity on MRI can signify brainstem stroke in posterior circulation stroke [ 1 ]. In cases of suspected posterior circulation stroke, it is recommended to perform an MRI of the brain, including diffusion-weighted imaging (DWI) and T2-weighted imaging, to assess for brainstem infarction [ 1 ]. The presence of T2 hyperintensity in the brainstem, particularly in the pons, midbrain, or medulla, can indicate ischemic damage.
Key Considerations
- Prompt recognition and evaluation are crucial, as brainstem strokes can have severe consequences [ 1 ].
- Treatment may involve antithrombotic therapy, such as aspirin 81-325 mg daily, and management of underlying risk factors [ 1 ].
- In some cases, thrombectomy or other interventions may be considered.
- Close monitoring and neurological assessment are essential to guide management and prevent further complications.
Imaging Recommendations
- For patients within a 3-hour time period from onset of symptoms, either NECT or MRI is recommended before intravenous tPA administration to exclude ICH and to determine whether CT hypodensity or MRI hyperintensity of ischemia is present [ 1 ].
- MR-DWI surpasses NECT and other MR sequences for the detection of acute ischemia [ 1 ].
From the Research
T2 Hyperintensity and Brainstem Infarction
- T2 hyperintensity can be an indicator of brainstem infarction in posterior circulation stroke, as shown in a study published in 2018 2.
- The study found that hyperintense endo-vessels sign (HEVs) on transverse section MRI was detected in 15 of 18 patients (83.3%) with occlusion of the vertebral artery or basilar artery, and 17 of 23 (73.9%) showed severe stenosis.
- Additionally, MRI DWI showed that 14 patients had brainstem infarction among 15 basilar artery HEVs patients, and all of the 9 vertebral and basilar artery HEVs patients had brainstem infarction.
Clinical Significance of T2 Hyperintensity
- T2 hyperintensity has been associated with poor clinical outcome in patients with supratentorial ischemic stroke, as shown in a study published in 2000 3.
- The study found that pontine hyperintensity (PHI) was related to a higher frequency and larger volume of supratentorial brain infarcts, and was an independent correlate of poor 15-month outcome.
- Another study published in 2004 4 found that T2-hyperintense foci can pose serious diagnostic problems, and can be associated with various conditions, including ischemic changes, vasculitis, and multiple sclerosis.
Diagnostic Accuracy of T2 Hyperintensity
- A study published in 2013 5 found that medial lemniscus T2 hyperintensity (MLH) can be a reliable imaging marker for small vessel disease (SVD), but requires a higher threshold application to ROI measurements to eliminate false positives.
- Another study published in 1997 6 found that the factors and symptomatology associated with different types of hyperintensity lesions on MRI can vary, and that symptomatic patients tend to have a higher incidence of hypertension and electrocardiographic abnormalities.