Prominent Vessel Sign on Susceptibility-Weighted Imaging in Acute Stroke: Prediction of Infarct Growth and Clinical Outcome

Abstract

Background and PurposePredicting the risk of further infarct growth in stroke patients is critical to therapeutic decision making. We aimed to predict early infarct growth and clinical outcome from prominent vessel sign (PVS) identified on the first susceptibility-weighted image (SWI) after acute stroke.Materials and MethodsTwenty-two patients with middle cerebral artery (MCA) infarction had diffusion-weighted imaging, SWI, MR angiography, and clinical evaluation using the National Institutes of Health Stroke Scale at 7–60 hours and 5–14 days after stroke onset. Late-stage clinical evaluation at 1 and 3 months used the modified Rankin Scale. The infarct area and growth were scored from 10 (none) to 0 (infarct or growth in all 10 zones) using the Alberta Stroke Program Early CT Score (ASPECTS) system.ResultsInfarct growth on the second MRI occurred in 13 of 15 patients with PVS on the first MRI and not in any patient without PVS (n=7; r=0.86, P<0.001). The extent of PVS was significantly correlated with infarct growth (r=0.82, P<0.001) and early-stage outcome (P=0.02). No between-group difference in late-stage clinical outcome was found.ConclusionPVS on the first SWI after acute MCA territory stroke is a useful predictor of early infarct growth. Extensive PVS within the large MCA territory is related to poor early-stage outcome and could be useful for clinical assessment of stroke.

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

“…PHVS existed not only in the hyperacute ischaemic stroke but also beyond the reperfusion window time [13, 14, 18, 21, 22]. However, the relationship between PHVS beyond the reperfusion window period and clinical outcome remains controversial.…”

“…Some previous studies revealed that PHVS occurred beyond the reperfusion window time that was related to poor outcome, while some studies found that PHVS was not associated with the 3-month prognosis [13, 18, 21, 22]. The current study substantiated that PHVS correlated with the poor outcome beyond the reperfusion window, which might be attributed to the following reasons: The patients who underwent SWI after the window of reperfusion therapy presented PHVS that represented misery perfusion [21].…”

“…Alberta Stroke Program Early CT Score (ASPECTS) was evaluated on DWI and SWI separately [18-20]. DWI was assessed to find the ischaemic region that was quantified using the ASPECTS [19].…”

“…The PHVS of the thalamostriate vein was recorded as 3 scores (C, L or IC), as this vein drains the caudate nucleus, lentiform nucleus and internal capsule. The SWI-ASPECTS was scored from 10 (no PHVS) to 0 (PHVS in M1, M2, M3, M4, M5, M6, I, C, L or IC) [18]. …”

Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke

“…[1][2][3] Susceptibility-weighted imaging is useful for evaluating cerebral veins in AIS because it is extremely sensitive to paramagnetic substances such as deoxyhemoglobin, thus reflecting the oxygen extraction fraction and the cerebral metabolic rate of oxygen of the hypoxic tissue. [1][2][3][4] Shortly after vascular occlusion, the uncoupling between oxygen supply and demand in the hypoperfused region leads to an elevated oxygen extraction fraction and subsequent increased level of deoxyhemoglobin in the vessel, which contributes to prominent hypointensity of the draining veins on SWI. [5][6][7] Asymmetric cortical veins, which can be visualized on SWI after AIS and are considered an indicator of salvageable ischemic penumbra, were found to be associated with 3-month outcome.…”