Thrombus Permeability in Admission Computed Tomographic Imaging Indicates Stroke Pathogenesis Based on Thrombus...

Area of Science:

• Neurology
• Radiology
• Pathology

Background:

• Intracranial thrombi characterization by permeability (contrast agent penetration) is crucial.
• Thrombus composition and pathogenesis significantly impact stroke treatment and prevention.
• Understanding thrombus heterogeneity is key to improving patient outcomes.

Purpose of the Study:

• To explore histopathologic factors explaining thrombus permeability variations.
• To evaluate correlations between thrombus permeability and stroke pathogenesis.
• To validate thrombus permeability as an imaging marker for stroke cause.

Main Methods:

• Thrombus densities measured using thin-slice noncontrast CT and CT angiography in 133 patients with middle cerebral artery occlusions.
• Calculated thrombus attenuation change (Δt) and corrected void fraction (ε) to estimate permeability.
• Correlated permeability measures with histological thrombus components and stroke pathogenesis in two cohorts (n=32 and n=101).

Main Results:

• Thrombus permeability correlated positively with fibrin-platelet fractions and inversely with red blood cell counts.
• Higher permeability (Δt) observed in cardioembolic stroke thrombi compared to noncardioembolic ones.
• Validation cohort confirmed significant differences in permeability between cardioembolic and noncardioembolic thrombi.

Conclusions:

• Permeable thrombi are associated with lower red blood cell fractions and higher fibrin-platelet content.
• Thrombus permeability is a potential imaging marker for identifying cardioembolic stroke origin.
• This simple imaging marker can aid in early stroke diagnosis and management.