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. 2019 Jan;47(1):196-205.
doi: 10.1177/0300060518799019. Epub 2018 Sep 21.

Susceptibility-weighted imaging in post-treatment evaluation in the early stage in patients with acute ischemic stroke

Jia Liang  1 , Peiyi Gao  1   2   3 , Yan Lin  2 , Ligang Song  4 , Haiqiang Qin  5 , Binbin Sui  1   2   3
Affiliations

Susceptibility-weighted imaging in post-treatment evaluation in the early stage in patients with acute ischemic stroke

Jia Liang et al. J Int Med Res. 2019 Jan.

Abstract

Objective: This study aimed to investigate the association between abnormal signs on susceptibility-weighted imaging (SWI) and post-treatment outcome in the early stage in patients with acute ischemic stroke.

Methods: Thirty-seven patients with middle cerebral artery territory infarction were recruited. Baseline and 24-hour follow-up magnetic resonance imaging was performed. Pre- and 24-hour post-treatment clinical conditions were assessed with the National Institutes of Health Stroke Scale (NIHSS) score. Prominent vessel sign (PVS) on SWI and infarcted areas on diffusion-weighted imaging (DWI) were assessed using the Alberta Stroke Program Early CT (ASPECT) score system. Susceptibility vessel sign (SVS) was evaluated and recorded. The associations between image abnormalities and clinical scores were analyzed.

Results: PVS was found in 35 patients and SVS in seven patients. The extent of PVS was significantly correlated with the post-treatment DWI ASPECT score (r = 0.79), but not with the post-treatment NIHSS score or the post-pre NIHSS difference score. The presence of SVS was significantly correlated with the post-treatment NIHSS score (r = 0.41).

Conclusion: PVS might be a useful predictor of early imaging prognosis and infarct growth in patients with acute ischemic stroke. SVS is related to a poor early outcome and could be useful for assessing stroke.

Keywords: Acute ischemic stroke; clinical outcome; infarction; magnetic resonance imaging; middle cerebral artery; susceptibility vessel sign; susceptibility-weighted imaging.

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Figures

Figure 1.
Figure 1.
(a) Prominent vessel sign can be seen at the right frontal and parietal lobe, with an increased number and diameter of veins compared with the contralateral side. (b) Susceptibility vessel sign can be seen at the M1 segment of the right middle cerebral artery, displaying intense low-signal intensity in the artery with enlargement of the diameter of the right MCA
Figure 2.
Figure 2.
Magnetic resonance images of a 45-year-old man. The baseline and follow-up National Institutes of Health Stroke Scale score was 10 and 6, respectively. (a–c) Baseline susceptibility-weighted imaging minimal intensity projection images show susceptibility vessel sign at the right middle cerebral artery. Prominent vessel sign can be seen at the right middle cerebral artery territory, with an Alberta Stroke Program Early CT score of 4. (d) Baseline diffusion-weighted imaging shows infarction in right basal ganglia, with an Alberta Stroke Program Early CT score of 6. (e) Follow-up magnetic resonance imaging was carried out at 27 hours after baseline imaging. Diffusion-weighted imaging shows enlargement of the infarction, with an Alberta Stroke Program Early CT score of 4. The abnormal area corresponds with the susceptibility-weighted imaging–prominent vessel sign area. (f) A follow-up fluid attenuation inversion recovery image shows a high-signal intensity area at the right temporal lobe, and right insular and right basal ganglia area, which also corresponds with the abnormal susceptibility-weighted imaging–prominent vessel sign area. (g) Baseline minimal intensity projection image of three-dimensional time-of-flight magnetic resonance angiography shows arterial occlusion without distal branches of the right middle cerebral artery. (h–i) Follow-up three-dimensional time-of-flight magnetic resonance angiography shows that the middle cerebral artery is not recanalized after thrombolysis treatment
See this image and copyright information in PMC

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