Evaluation of Occluded Distal Vessels with Variable Flip-Angle 3-Dimensional Turbo Spin-Echo Magnetic Resonance Imaging Before Acute Mechanical Thrombectomy

Aihara, Masanori; Shimizu, Tatsuya; Yamaguchi, Rei; Aishima, Kaoru; Shimauchi, Hiroya; Wada, Hajime; Shintoku, Ryosuke; Yoshimoto, Yuhei

doi:10.1016/j.wneu.2022.08.085

Cited by 2 publications

(4 citation statements)

References 16 publications

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“…This new model (ECHELON Smart, FUJIFILM; MAGNETOM Avanto, Siemens Healthcare GmbH, Erlangen, Germany; SIGNA Explorer, GE Healthcare, Chicago, IL; Achieva, Philips Medical Systems) has the possibility of resolving these disadvantages, including the quality of imaging, scan time, and visualization of thrombus size and length. The usefulness of modified 3D T1-weighted imaging with VRFA-TSE using 1.5-T MRI for clearly depicting the cerebral vessels, including the occluded invisible lesion, has already been reported, but again the thrombus size and length could not be depicted clearly (8). Further investigations with 3D PDW-VRFA-TSE using 1.5-T MRI are needed.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery

Kumagai,

Hayashi,

Takahashi

et al. 2023

Acta Radiol

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Background Endovascular thrombectomy (EVT) is performed for acute ischemic stroke (AIS) caused by large vessel occlusion; therefore, preoperative visualization of the occluded invisible vessel course reduces complications and ensures success. Three-dimensional (3D) proton density-weighted (PDW) vessel wall imaging (VWI) using variable refocusing flip angle pulse-turbo spin-echo sequences (VRFA-TSE) with 3.0-T magnetic resonance imaging (MRI) can provide this information. Purpose To assess the effectiveness of 3D PDW-VWI using 1.5-T MRI without VRFA function. Material and Methods Five consecutive patients with AIS caused by large vessel occlusion underwent EVT in our institute. VWI with 1.5-T MRI using 3D PDW-fast spin echo (FSE) technique was added to conventional brain imaging. Results PDW-FSE was successfully performed in all cases. 3D PDW-FSE was useful to visualize both the anterior and posterior circulations by clearly revealing invisible vessels but could not demonstrate the length and size of the clot in all five cases. Conclusion 3D PDW-FSE with 1.5-T MRI without VRFA could clearly depict the course of the invisible occluded artery and might support favorable outcomes after EVT in patients with AIS.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery

Kumagai,

Hayashi,

Takahashi

et al. 2023

Acta Radiol

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“…To overcome this challenge, there have been efforts to visualize the distal-to-thrombus segment before thrombectomy using various sequences of MRI, [ 7 , 8 , 9 , 10 , 11 , 12 ] or intra-arterial cone-beam CT angiography [ 13 , 14 , 15 ]. Arterial structural anatomy can be shown by the time of flight-magnetic resonance angiography (TOF-MRA) when there is a detectable signal of blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…In acute ischemic stroke patients, however, TOF-MRA does not show branching patterns with no detectable flow signal beyond the large vessel occlusion. Using a fusion image with TOF-MRA, a T2-weighed high-resolution vessel wall MRI or 3D cisternography acquired by a heavily T2-weighted MRI sequence can outline vessel anatomy ahead and behind the clot [ 7 , 8 , 9 , 10 , 11 , 12 ]. Flat panel detector or cone-beam CT angiographic images were obtained after an intra-arterial diluted contrast injection showing about 90% of excellent or good image quality and about 70% visualization of the distal portion to the occluded artery segment by using regrade flow [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although several approaches have been taken to visualize the distal-to-thrombus segment before thrombectomy using various sequences of magnetic resonance imaging (MRI) [ 7 , 8 , 9 , 10 , 11 , 12 ] and intra-arterial cone-beam CT [ 13 , 14 , 15 ], no effort has been made to visualize the distal-to-thrombus segment using non-contrast (NCT) and angiographic brain CT (CTA), which is a routine imaging protocol to triage acute stroke patients. Although NCT can detect thrombus by hyperdense arterial signs, it remains unknown whether NCT can track the arterial trajectory distal to the occlusion site in a patient with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Piecing Arterial Branching Pattern Together from Non-Contrast and Angiographic Brain Computed Tomography before Endovascular Thrombectomy for Acute Ischemic Stroke

Lee

Shim

Jeong

et al. 2023

JCM

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Predicting the unseen arterial course and branching pattern distal to vessel occlusion is crucial for endovascular thrombectomy in acute stroke patients. We investigated whether a comprehensive interpretation of NCT and CTA would enhance arterial course prediction more than either NCT or CTA interpretation alone. Among 150 patients who achieved post-thrombectomy TICI grades ≥ IIb for anterior circulation occlusions, we assessed visualization grade on both NCT and CTA by five scales at the thrombosed and the distal-to-thrombus segment, using DSA as the reference standard. The visualization grades were compared and related to various subgroups. The mean visualization grade of the distal-to-thrombus segment on NCT was significantly larger than that of CTA (mean ± SD, 3.62 ± 0.87 versus 3.31 ± 1.20; p < 0.05). On CTA, visualization grade of distal-to-thrombus segment in the good collateral flow subgroup was higher than that in the poor collateral flow subgroup (mean ± SD, 4.01 ± 0.93 versus 2.56 ± 0.99; p < 0.001). After the comprehensive interpretation of NCT and CTA, seventeen cases (11%) showed visualization grade of distal-to-thrombus segment upgrading. Tracing arterial course and piecing branching patterns together in distal-to-occlusion of stroke patients was feasible on the routine pre-interventional NCT and CTA, which may provide timely guidance during thrombectomy.

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Evaluation of Occluded Distal Vessels with Variable Flip-Angle 3-Dimensional Turbo Spin-Echo Magnetic Resonance Imaging Before Acute Mechanical Thrombectomy

Cited by 2 publications

References 16 publications

Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery

Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery

Piecing Arterial Branching Pattern Together from Non-Contrast and Angiographic Brain Computed Tomography before Endovascular Thrombectomy for Acute Ischemic Stroke

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