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Updated: Mar 28, 2026
A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
Extensive blooming artifact predicts no recanalization after intravenous thrombolysis
1Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
Background And Purpose:
Hemosiderin exhibits a stronger T2 shortening effect than deoxyhemoglobin. The extent of the 'blooming artifact' may therefore reflect a composition of different iron forms. Our aim was to investigate the relationship between extent of susceptibility vessel sign (SVS) width beyond the lumen and middle cerebral artery (MCA) recanalization.
Methods:
Clinical and imaging data from consecutive acute ischaemic stroke patients with MCA occlusion who underwent susceptibility-weighted imaging (SWI) before intravenous thrombolysis were examined. The source images of magnitude and angiography were used to obtain the width of SVS and MCA at the interface, respectively.
Results:
The presence of MCA SVS was observed in 64 patients on initial SWI scans and recanalization was observed in 30 (46.9%) patients. The overestimation ratio of thrombus width on SWI was an acceptable predictor for no recanalization [odds ratio 1.360 per 0.1; 95% confidence interval (CI) 1.093-1.691; P = 0.006]. The optimal cut-off point was identified at 1.943, and this yielded a sensitivity of 67.6% and a specificity of 86.7%. Extensive blooming artifact, defined as overestimation ratio ≥2, independently predicted no recanalization (odds ratio 9.687, 95% CI 1.974-47.545; P = 0.005) and unfavorable outcome (odds ratio 4.916, 95% CI 1.049-23.051; P = 0.043).
Conclusions:
The extent of SVS width beyond the lumen might reflect the content of hemosiderin. An extreme overestimation ratio might indicate aged thrombus, which may be resistant to thrombolysis.
