ObjectivesSusceptibility-weighted imaging (SWI) enables visualization of thrombotic material in acute ischemic stroke. We aimed to validate the accuracy of thrombus depiction on SWI compared to time-of-flight MRA (TOF-MRA), first-pass gadolinium-enhanced MRA (GE-MRA) and digital subtraction angiography (DSA). Furthermore, we analysed the impact of thrombus length on reperfusion success with endovascular therapy.MethodsConsecutive patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusions undergoing endovascular recanalization were screened. Only patients with a pretreatment SWI were included. Thrombus visibility and location on SWI were compared to those on TOF-MRA, GE-MRA and DSA. The association between thrombus length on SWI and reperfusion success was studied.ResultsEighty-four of the 88 patients included (95.5 %) showed an MCA thrombus on SWI. Strong correlations between thrombus location on SWI and that on TOF-MRA (Pearson’s correlation coefficient 0.918, P < 0.001), GE-MRA (0.887, P < 0.001) and DSA (0.841, P < 0.001) were observed. Successful reperfusion was not significantly related to thrombus length on SWI (P = 0.153; binary logistic regression).ConclusionsIn MCA occlusion thrombus location as seen on SWI correlates well with angiographic findings. In contrast to intravenous thrombolysis, thrombus length appears to have no impact on reperfusion success of endovascular therapy.Key Points• SWI helps in assessing location and length of thrombi in the MCA• SWI, MRA and DSA are equivalent in detecting the MCA occlusion site• SWI is superior in identifying the distal end of the thrombus• Stent retrievers should be deployed over the distal thrombus end• Thrombus length did not affect success of endovascular reperfusion guided by SWI

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Radiological investigations are common medical practice for the diagnosis of peripheral vascular diseases. Existing visualization methods such as Curved Planar Reformation (CPR) depict calcifications on vessel walls to determine if blood is still able to flow. While it is possible with conventional CPR methods to examine the whole vessel lumen by rotating around the centerline of a vessel, we propose Curvicircular Feature Aggregation (CFA), which aggregates these rotated images into a single view. By eliminating the need for rotation, vessels can be investigated by inspecting only one image. This method can be used as a guidance and visual analysis tool for treatment planning. We present applications of this technique in the medical domain and give feedback from radiologists.

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