Prominent Hypointense Vessel Sign on Susceptibility-Weighted Imaging Is Associated with Clinical Outcome in Acute Ischaemic Stroke

Abstract

Background: Prominent hypointense vessel sign (PHVS) is visualized on susceptibility weighted-imaging (SWI) in acute ischaemic stroke (AIS). We aim to test if PHVS is associated with stroke outcome. Methods: Forty patients with acute middle cerebral artery occlusion were recruited. The presence of PHVS, cortical vessel sign (CVS), brush sign (BS) and susceptibility-diffuse weighted imaging mismatch (S-D mismatch) and Alberta Stroke Program Early CT Score (ASPECTS) on SWI were compared between the good outcome group (90-day modified Rankin scale [mRS] of 0–2) and the poor outcome group (mRS of 3–6). The receiver operating characteristic curves (ROC) were used to evaluate the predictive ability to poor outcome of above imaging characteristics. Results: The presence of PHVS, CVS, BS and S-D mismatch was significantly higher in the poor outcome group (p < 0.001, p = 0.001, p = 0.013, p = 0.014, respectively). SWI-ASPECTS was significantly lower in the poor outcome group (p = 0.002). Regression analysis revealed SWI-ASPECTS; the presence of PHVS and CVS were independently associated with poor outcome (OR 0.347, p = 0.012; OR 55.77, p = 0.004; OR 58.05, p = 0.005). ROC analysis showed that PHVS had the highest predictive value for poor outcome (AUC 0.783). Conclusions: The presence of PHVS, CVS and SWI-ASPECTS were associated with poor outcome in AIS. The presence of PHVS was the most effective radiographic marker for predicting outcome.

Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date

“…During the initial search, 1,018 studies were identified, 954 were initially screened by title and abstract, and 65 were assessed via a full-text review for eligibility. A total of 15 studies presented a relationship between T2*MRI findings and clinical/radiological outcomes in ischemic stroke patients after reperfusion therapy [ 5 , 13 - 26 ]. One study was a randomized controlled trial, while the other enrolled studies were observational studies.…”

“…Although we enrolled six studies by consensus after reviewing the figures and contexts of each, the definition of prominent hypointense vessel signs ( Fig. 1B ) at the ipsilateral side of stroke and its assessing methods were not consistent in six studies [ 21 - 26 ]. Thus, we did not conduct the pooled analysis for studies of PHVS.…”

Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke

“…Some studies suggest that ACVS could be used as an indicator of hypoperfusion in patients with ICA stenosis (Mundiyanapurath et al., 2016) and acute thromboembolic occlusion (Baik et al., 2012). The mismatch between ACVS on SWI and lesions on DWI corresponds to the penumbra of the acute infarct (Lou et al., 2014; Wang et al., 2018). However, the utility of ACVS in predicting the prognosis of AIS patients with IVT remained unclear.…”

“…Susceptibility‐weighted imaging (SWI), an MRI sequence that is highly sensitive to paramagnetic materials such as deoxyhemoglobin and hemosiderin (Huang et al., 2012; Miyasaka et al., 2012), can provide indirect information on regional perfusion status (Kao, Tsai, & Hasso, 2012). In recent years, the novel SWI‐MRI marker asymmetrical cortical vessel sign (ACVS) has been associated with poor outcomes in anterior circulation AIS patients who had not undergone IVT therapy (Sun et al., 2014; Wang et al., 2018). However, to our knowledge, there has been no study of ACVS in patients following IVT.…”

Dynamic Change in the Prominent Vessel Sign according to the Perfusion Status

“…The PVS predicted infarct growth, early neurological deterioration, and poor outcome. 1,2 However, there is a lack of data showing how the PVS present on SWI may change dynamically.…”