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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Sequential MR Assessment of the Susceptibility Vessel Sign and Arterial Occlusion in Acute Stroke
Thomas Ritzenthaler1,2, Audrey Lacalm3, Tae-Hee Cho1,2
1Cerebrovascular Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Bron Cedex, France.
Purpose:
Susceptibility vessel sign (SVS) may likely influence recanalization after thrombolysis. We assessed, through the European sequential MRI database "I-KNOW," the relationship between the presence of SVS on T2-weighted gradient echo imaging, its angiographic counterpart on magnetic resonance angiography and its subsequent impact on recanalization after thrombolysis.
Materials And Methods:
Initial clinical and MRI characteristics and early follow up were analyzed in acute ischemic stroke patients treated with rt-Pa within 4.5 hours. Patients underwent multimodal MRI at admission. Sequential imaging performed 3 hours, 2 days and 1 month later allowed the analysis of SVS changes and recanalization.
Results:
Fifty patients were included in the study. SVS was observed in 54% of cases at admission. SVS was still present in 46% patients at 3 hours, 16% at 2 days, and 0% at 1 month. It was an independent predictor of no recanalization after thrombolysis (P = .04). After 3 hours, SVS disappeared in only 4 cases, and was not linked with recanalization on MRA. Conversely, when SVS persisted, a partial or complete recanalization was observed in 9 and 6 cases, respectively.
Conclusions:
SVS is a predictor of lower recanalization rate. Its disappearance is not necessarily correlated with recanalization.
Insights
The susceptibility vessel sign (SVS) predicts lower recanalization rates after thrombolysis for acute ischemic stroke. SVS persistence, not disappearance, correlated with recanalization, highlighting its prognostic value.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Stroke Imaging
Background:
- The susceptibility vessel sign (SVS) is a potential imaging biomarker in acute ischemic stroke.
- Its precise role in predicting recanalization after thrombolysis requires further investigation.
Purpose of the Study:
- To evaluate the relationship between the susceptibility vessel sign (SVS) and recanalization rates following thrombolysis.
- To assess the impact of SVS presence and disappearance on treatment outcomes in acute ischemic stroke patients.
Main Methods:
- Analysis of the European
- I-KNOW
- database including 50 acute ischemic stroke patients treated with rt-PA.
- Multimodal MRI at admission and sequential imaging at 3 hours, 2 days, and 1 month to assess SVS and recanalization.
Main Results:
- Susceptibility vessel sign (SVS) was present in 54% of patients at admission and persisted in 16% at 2 days.
- SVS was an independent predictor of no recanalization (P = .04).
- Persistence of SVS correlated with partial or complete recanalization, while its disappearance did not.
Conclusions:
- The susceptibility vessel sign (SVS) is associated with reduced recanalization rates after thrombolysis.
- SVS disappearance does not necessarily indicate successful recanalization, emphasizing the need for further imaging assessment.
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