Advantages of Susceptibility-Weighted Magnetic Resonance Sequences in the Visualization of Intravascular Thrombi in Acute Ischemic Stroke

Allibert, R.; Grand, C. Billon; Vuillier, Fabrice; Cattin, F.; Muzard, E.; Biondi, Alessandra; Moulin, Thierry; Medeiros, Elisabeth

doi:10.1111/ijs.12373

Cited by 23 publications

(24 citation statements)

References 19 publications

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“…As already mentioned, the sensitivity of T2* to detect acute intracranial thrombi is not perfect. 5,[10][11][12] This likely explains why 12 patients with arterial occlusion on admission MRA did not have SVS. Furthermore, SVS extension or regression might reflect structural or metabolic changes within the thrombus over time rather than true thrombus evolution, 15,16 which may explain why 10 patients had complete regression of SVS on follow-up MRI, despite persistent occlusion on MRA.…”

Section: February 2017mentioning

confidence: 99%

“…Furthermore, SVS extension or regression might reflect structural or metabolic changes within the thrombus over time rather than true thrombus evolution, 15,16 which may explain why 10 patients had complete regression of SVS on follow-up MRI, despite persistent occlusion on MRA. Although some MR sequences, such as susceptibility-weighted imaging, are more sensitive than T2* for thrombus detection, 10,17,18 they are more timeconsuming and particularly their use in the hyperacute stroke setting is questionable. Lastly, the purposely devised assessment of SVS extension relied on qualitative, although expertbased, visual image analysis.…”

Section: February 2017mentioning

confidence: 99%

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Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

Seners

Hurford

Tisserand

et al. 2017

Stroke

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Given our underlying hypothesis that thrombus extension underlies unexplained END, only patients with both arterial occlusion on admission and persistent occlusion on 24 hours imaging, in whom Background and Purpose-Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension. Methods-From our database of consecutively thrombolysed patients, we identified anterior circulation stroke patients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography. END was defined as ≥4 National Institutes of Health Stroke Scale-point deterioration on 24-hour clinical assessment and unexplained END as END without clear cause. The incidence of susceptibility vessel sign extension on T2* imaging, defined as any new occurrence or extension of susceptibility vessel sign from admission to 24-hour follow-up magnetic resonance, was compared between patients with unexplained END and those without END. Results-Of 120 eligible patients for the present study, 22 experienced unexplained END. Susceptibility vessel sign extension was present in 41 (34%) patients and was significantly more frequent in the unexplained END than in the no-END group (59% versus 29%, respectively; adjusted odds ratio=3.96; 95% confidence interval, 1.25-12.53; P=0.02). Conclusions-In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.

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Section: February 2017mentioning

confidence: 99%

Section: February 2017mentioning

confidence: 99%

Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

Seners

Hurford

Tisserand

et al. 2017

Stroke

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“…Although Allibert et al showed that the presence of an SVS in SWI was not associated with cardioembolism, 5 Horie et al showed that cardioembolic stroke was more frequently associated with the presence of an SVS in susceptibility weight angiography. 11 Our study, which analyzed the SVS quantitatively, showed that the increased SVS diameter was associated with cardioembolic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…5 For better use of this highly sensitive tool, we redefined the SVS as a hypointense signal independent of its size and quantitatively analyzed the SVS diameter and length in patients with acute ischemic stroke who underwent endovascular treatment. We assessed the correlation between the 2 SVS parameters and the stroke mechanism and that between the SVS volume and the recanalization status.…”

mentioning

confidence: 99%

Prediction of Stroke Subtype and Recanalization Using Susceptibility Vessel Sign on Susceptibility-Weighted Magnetic Resonance Imaging

Kang

Jeong

Kim

et al. 2017

Stroke

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“…For determining the site of occlusion, SWI exhibits better sensitivity and specificity than T2 gradient echo (Fig. 2) or 3D TOF imaging [17–19]. It is also much more effective in identifying distal thrombi, for both anterior [17, 20, 21] and posterior [19] localisations (Fig.…”

Section: Swi Sequencesmentioning

confidence: 99%

ASL and susceptibility-weighted imaging contribution to the management of acute ischaemic stroke

et al. 2016

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Magnetic resonance imaging (MRI) plays a central role in the early diagnosis of cerebral vascular events. Today, MRI is used not only for the detection of acute ischaemic lesions, but also to fine tune the diagnosis and improve patient selection for early therapeutic decision-making. In this perspective, new tools such as arterial spin labelling (ASL) and susceptibility-weighted imaging (SWI) sequences have been developed. These MRI sequences enable noninvasive assessment of brain damage, providing important diagnostic and prognostic information: evaluation of cerebral parenchymal perfusion; detection and aetiological assessment of thrombi; ruling out differential diagnoses. After a brief recall of the fundamental basis of these sequences, this article proposes an update on their current contribution to the early management of stroke victims.Teaching Points• These noninvasive sequences provide essential information for early management of acute stroke. • They can detect zones of parenchymal hypoperfusion. • Susceptibility-weighted sequences provide information on thrombus localisation and composition. • ASL can identify certain aetiologies of stroke mimics. • Post-therapeutic ASL perfusion status predicts outcome.

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Advantages of Susceptibility-Weighted Magnetic Resonance Sequences in the Visualization of Intravascular Thrombi in Acute Ischemic Stroke

Cited by 23 publications

References 19 publications

Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

Prediction of Stroke Subtype and Recanalization Using Susceptibility Vessel Sign on Susceptibility-Weighted Magnetic Resonance Imaging

ASL and susceptibility-weighted imaging contribution to the management of acute ischaemic stroke

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