The Prognostic Impact of Susceptibility-Weighted Imaging Prominent Veins in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Purpose:We aimed to determine the prognostic impact of prominent veins (PVS) after an acute ischemic stroke identified on susceptibility-weighted imaging (PVS-SWI). Methods: We searched for studies published in PubMed, Embase, Cochrane Library and Chinese Biomedical Literature Database. Poor functional prognosis, early neurological deterioration, and hemorrhagic transformation were evaluated. Risk ratios (RR) were pooled implementing a random effect model. We performed a subgroup analysis by treatment, location (cortical/medullary) and a sensitivity analysis by follow-up time. Results: Sixteen studies were included (a total of 1605 patients) in the quantitative metaanalysis. PVS-SWI were related with a poor functional outcome (RR 1.62, 95% CI 1.25 to 2.10), especially in the patients receiving thrombolysis (RR 2.19, 95% CI 1.53 to 3.15) and an augmented risk of early neurological damage (RR 2.85, 95% CI 2.31 to 3.51). Both cortical and medullary prominent veins were accompanied by a poor functional outcome (RR 1.82, 95% CI 1.30 to 2.56/RR 2.59, 95% CI 1.98 to 3.38). PVS-SWI were not associated with poor functional outcomes when patients were treated conservatively (RR 1.35, 95% CI 0.82 to 2.22), or with an increased risk of hemorrhagic transformation (RR 0.97, 95% CI 0.64 to 1.47). Conclusion: PVS-SWI were related to a poor functional prognosis and an increased risk of early neurological damage. In patients treated conservatively, PVS-SWI were not accompanied by a poor prognosis. PVS-SWI were not associated with an augmented risk of hemorrhagic transformation.

Prominent veins sign is associated with malignant cerebral edema after acute ischemic stroke

“…Regarding PVS-SWI, the latest quantitative meta-analysis included 16 cohort studies involving a total of 1605 patients, of which 11 studies concluded that the presence of PVS-SWI was related to poor prognosis in AIS, and 5 studies suggested no significant association. The meta-analysis showed that PVS-SWI was related to a poor 90-day functional prognosis and was more likely to show early neurological deterioration [ 10 ]. Unfortunately, this meta-analysis did not explore the correlation between PVS-SWI and malignant cerebral edema events, probably due to the lack of previous relevant studies.…”

“…PVS-SWI is related to the amount of deoxyhemoglobin in venous blood [ 8 ] and venous dilatation [ 9 ], indirectly reflecting the increased oxygen extraction fraction and hypoperfusion state. In previous studies, PVS-SWI was correlated with short-term functional outcomes, but its relationship with MCE outcome has not been systematically investigated [ 10 ].…”

Prognostic value of susceptibility-weighted imaging of prominent veins in acute ischemic stroke: A systematic review and meta-analysis

“…To date, 20 studies reported the relationship between PVS and the prognosis of patients with AIS, 15 of which believed that PVS had a worse prognosis than those without PVS ( 8 – 22 ), while the other 5 suggested that the presence of PVS was not related to prognosis ( 23 – 27 ). A previous meta-analysis has indicated that PVS was related to a poor functional prognosis in patients with AIS ( 28 ). However, it remains inconclusive whether PVS has an independent effect on prognosis in terms of pathophysiological factors such as large vessel occlusion.…”