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. 2015 Apr 7;10(4):e0120801.
doi: 10.1371/journal.pone.0120801. eCollection 2015.

Asymmetry of deep medullary veins on susceptibility weighted MRI in patients with acute MCA stroke is associated with poor outcome

Johanna Mucke  1 , Markus Möhlenbruch  1 , Philipp Kickingereder  1 , Pascal J Kieslich  2 , Philipp Bäumer  1 , Christoph Gumbinger  3 , Jan Purrucker  3 , Sibu Mundiyanapurath  3 , Heinz-Peter Schlemmer  4 , Martin Bendszus  1 , Alexander Radbruch  5
Affiliations

Asymmetry of deep medullary veins on susceptibility weighted MRI in patients with acute MCA stroke is associated with poor outcome

Johanna Mucke et al. PLoS One. .

Abstract

Background and purpose: Due to its sensitivity to deoxyhemoglobin, susceptibility weighted imaging (SWI) enables the visualization of deep medullary veins (DMV) in patients with acute stroke, which are difficult to depict under physiological circumstances. This study assesses the asymmetric appearance of prominent DMV as an independent predictor for stroke severity and outcome.

Materials and methods: SWI of 86 patients with acute middle cerebral artery (MCA) stroke were included. A scoring system from 0 (no visible DMV) to 3 (very prominent DMV) was applied for both hemispheres separately. A difference of scores between ipsi- and contralateral side was defined as asymmetric (AMV+). Occurrence of AMV+ was correlated with the National Institute of Health Stroke Scale (NIHSS) Score on admission and discharge, as well as the modified Rankin Scale (mRS) at discharge. Ordinal regression analysis was used to evaluate NIHSS and mRS as predictors of stroke severity, clinical course of disease and outcome.

Results: 55 patients displayed AMV+ while 31 did not show an asymmetry (AMV-). Median NIHSS on admission was 17 (11-21) in the AMV+ group and 9 (5-15) in the AMV- group (p = 0.001). On discharge median NIHSS was 11 (5-20) for AMV+ and 5 (2-14) for AMV- (p = 0.005). The median mRS at discharge was 4 (3-5) in the AMV+ group and 3 (1-4) in AMV- (p = 0.001). Odds ratio was 3.19 (95% CI: 1.24-8.21) for AMV+ to achieve a higher mRS than AMV- (p = 0.016).

Conclusion: The asymmetric appearance of DMV on SWI is a fast and easily evaluable parameter for the prediction of stroke severity and can be used as an additional imaging parameter in patients with acute MCA stroke.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scoring system for the quantification of DMV.
A) 0 = no visible DMV B) 1 = faintly visible DMV C) 2 = unequivocal visible DMV D) 3 = very prominent DMV.
Fig 2
Fig 2. Patient with right MCA infarction.
A) Reduced perfusion within the territory of the right MCA. B) Asymmetric appearance of prominent periventricular DMV within the infarcted area (arrows).
See this image and copyright information in PMC

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