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Comparative Study
. 2013 May 23;8(5):e63459.
doi: 10.1371/journal.pone.0063459. Print 2013.

Comparison of susceptibility weighted imaging and TOF-angiography for the detection of Thrombi in acute stroke

Alexander Radbruch  1 , Johanna Mucke, Ferdinand Schweser, Andreas Deistung, Peter Alexander Ringleb, Christian Herbert Ziener, Matthias Roethke, Heinz-Peter Schlemmer, Sabine Heiland, Jürgen R Reichenbach, Martin Bendszus, Stefan Rohde
Affiliations
Comparative Study

Comparison of susceptibility weighted imaging and TOF-angiography for the detection of Thrombi in acute stroke

Alexander Radbruch et al. PLoS One. .

Abstract

Background and purpose: Time-of-flight (TOF) angiography detects embolic occlusion of arteries in patients with acute ischemic stroke due to the absence of blood flow in the occluded vessel. In contrast, susceptibility weighted imaging (SWI) directly enables intravascular clot visualization due to hypointense susceptibility vessel signs (SVS) in the occluded vessel. The aim of this study was to compare the diagnostic accuracy of both methods to determine vessel occlusion in patients with acute stroke.

Methods: 94 patients were included who presented with clinical symptoms for acute stroke and displayed a delay on the time-to-peak perfusion map in the territory of the anterior (ACA), middle (M1, M1/M2, M2/M3) or posterior (PCA) cerebral artery. The frequency of SVS on SWI and vessel occlusion or stenosis on TOF-angiography was compared using the McNemar-Test.

Results: 87 of 94 patients displayed a clearly definable SVS on SWI. In 72 patients the SVS was associated with occlusion or stenosis on TOF-angiography. Fifteen patients exclusively displayed SVS on SWI (14 M2/M3, 1 M1), whereas no patient revealed exclusively occlusion or stenosis on TOF-angiography. Sensitivity for detection of embolic occlusion within major vessel segments (M1, M1/M2, ACA, and PCA) did not show any significant difference between both techniques (97% for SWI versus 96% for TOF-angiography) while the sensitivity for detection of embolic occlusion within M2/M3 was significantly different (84% for SWI versus 39% for TOF-angiography, p<0.00012).

Conclusions: SWI and TOF-angiography provide similar sensitivity for central thrombi while SWI is superior for the detection of peripheral thrombi in small arterial vessel segments.

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Conflict of interest statement

Competing Interests: This study was partly funded by Guerbet. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
Figure 1. Patient with acute right-hemispheric-stroke.
Time-to-peak perfusion map (A) displays impaired perfusion in the area of the right middle cerebral artery (MCA), while TOF-angiography demonstrates occlusion of the right MCA in the M1 segment (B). Typical appearance of a Susceptibility vessel sign (SVS) on SWI is shown in (C).
Figure 2
Figure 2. Patient with symptoms of acute stroke presenting SVS without correlation on TOF-Angiography.
Diagnosis of acute ischemic stroke based on reduced time-to-peak perfusion (A). On TOF-Angiography (B) no occlusion or stenosis can be detected in left hemispherical arteries. In contrast, the thrombus in the peripheral segment of the MCA is clearly seen on SWI (C). Co-registration of SWI and TOF-angiography data, obtained with the Siemens fusion tool (D), highlights the TOF-angiography signal within the SVS.
Figure 3
Figure 3. Distribution of observed SVS on SWI and occlusion/stenosis on TOF images in patients with delayed perfusion.
15 of 94 patients presented SVS on SWI without a corresponding occlusion or stenosis on TOF-angiography. In contrast, no patient presented an occlusion or stenosis on TOF-angiography without a corresponding SVS on SWI. Only 7 patients did not present any SVS at all.
Figure 4
Figure 4. Thrombus delineation despite strong motion artifacts.
Patient with symptoms of acute right hemispheric stroke and delayed time-to-peak perfusion in the M1 territory of the right MCA (A). TOF-angiography demonstrates occlusion of the right MCA (B). Despite strong motion artifacts the SVS can still be clearly delineated in the right MCA on SWI (C).
See this image and copyright information in PMC

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