Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

Jiang, Haifei; Zhang, Yiqun; Pang, Jiangxia; Pei-ning, Shao; Qiu, Hancheng; Liu, Aofei; Li, Chen; Jin, Min; Man, Fengyuan; Jiang, Weijian

doi:10.1038/s41598-021-84269-8

Cited by 13 publications

(9 citation statements)

References 25 publications

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“…Two cases of acute infarction in our study did not show PVS on (SWI) and this matched with Jiang, Hf et al, who stated that the presence of PVS is independently linked to large vessel occlusion, cardioembolism, and anterior circulation infarct [13].…”

Section: Discussionsupporting

confidence: 91%

“…SWI applications in the eld of acute infarction are promising as they have signi cantly greater sensitivity and better contrast resolution for the detection of thromboembolus. Applications of SWI include detecting intracerebral hemorrhage, identifying intra-arterial thrombus, diagnosing occult vascular malformations, and evaluating cerebral hemodynamics after stroke [13].…”

Section: Discussionmentioning

confidence: 99%

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Additive Role of Susceptibility weighted image To Diffusion weighted image in the diagnosis Of Patients with Acute Stroke

Rahma

Khadrah

Elsafa

et al. 2022

Preprint

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Background Acute ischemic stroke is defined as decrease in the brain blood supply caused by a blood vessel burst or being blocked by a thrombus, resulting in decreased oxygen and nutrients supply, causing brain tissue damage. Diffusion weighted sequences (DWI) gave us data on the pathophysiology of ischemia and may contribute to therapeutic decisions. Susceptibility weighted (SWI) sequences also have the potential to assess tissue viability. An ischemic area showed increased oxygen extraction fraction and slow flow contributed to greater level of deoxyhemoglobin and vein dilatation, which increases the prominence of vessels on SWI. This prominent vessel sign (PVS) on SWI has been reported due to increased oxygen extraction and matches well with venous and capillary deoxyhemoglobin levels. We aimed in this study to highlight the role of the addition of susceptibility weighted MR images to diffusion weighted images of the brain in the diagnosis of patients with acute stroke. Results: Prominent vessel sign (PVS) on SWI was found in 46 (76.7%) patients. Twelve (20%) patients had haemorrhage (low signals) on SWI and 2 (3.3%) patients had no SWI findings. DWI showed a sensitivity of (100%) and SWI showed a sensitivity of (96.7%) for the detection of infarct All of the 60 (100%) patients showed hyperintense signals on T2WIs, FLAIR sequences, and on DWI and hypointense signals on the ADC map. Conclusions: SWI is a potential adjunct in individuals with acute infarction, SWI may be helpful in identifying asymmetrical conspicuous hypointense arteries, positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a prognostic indicator for infarct expansion.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Additive Role of Susceptibility weighted image To Diffusion weighted image in the diagnosis Of Patients with Acute Stroke

Rahma

Khadrah

Elsafa

et al. 2022

Preprint

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“…Meanwhile, we also found that patients with severe DMVs had higher baseline NIHSS scores, and greater proportions of large infarction. Similarly, several previous studies have found that prominent DMVs groups had higher admission NIHSS scores and were prone to develop HT and large infarction size [ 13 , 16 , 27 ]. Resulting from the sudden decrease of cerebral blood flow, poor establishment of collateral circulation, and severe blood–brain barrier dysfunction, severe DMVs may share common pathophysiological mechanisms with hemorrhagic transformation and large infarction, along with greater stroke severity and consequently, worse clinical outcomes [ 44 ].…”

Section: Discussionsupporting

confidence: 54%

“…Both the pathophysiological processes can affect the appearance of DMVs, as mentioned above. Additionally, a recent prospective study indicated that cardio-embolism might be independently associated with the prominent vessel sign on SWI [ 27 ]. It was proposed that cardioembolic thrombus of medium to large size could both lead to the presence of prominent DMVs under the circumstance of acute cerebral parenchymal and/or cortical ischemia.…”

Section: Introductionmentioning

confidence: 99%

Association between Deep Medullary Veins in the Unaffected Hemisphere and Functional Outcome in Acute Cardioembolic Stroke: An Observational Retrospective Study

Liu

Wei

et al. 2022

Brain Sciences

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Objective: To explore whether deep medullary veins (DMVs) in the unaffected hemisphere were associated with functional outcome in acute cardioembolic stroke patients. Methods: Acute cardioembolic stroke patients at a single center were retrospectively included. DMVs visibility in the unaffected hemisphere was assessed using a well-established four-grade scoring method based on susceptibility-weighted imaging (SWI): grades 0–3 (grade 0 for no visible DMVs; grade 1 for the numbers of conspicuous DMVs < 5; grade 2 for numbers raging from 5 to 10; grade 3 for more than 10). Patients were further divided into mild-to-moderate (grade 0–2) and severe DMVs (grade 3) groups. Functional outcomes were evaluated using the modified Rankin scale (mRS) score at three months. Poor outcome was defined as mRS ≥ 3. Binary logistic regression analysis was used to explore the association between DMVs grade and functional outcome. Results: A total of 170 patients were finally included. Compared with the mild-to-moderate DMVs group (149 patients), the severe DMVs group (21 patients) had higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.002), lower levels of admission systolic blood pressure (BP) (p = 0.031), and elevated rates of large infarction (p = 0.003). At three months, the severe DMVs group had higher mRS (p = 0.002). Patients in the poor outcome group (82/170, 48.2%) had older age, higher baseline NIHSS score, lower admission diastolic BP, higher rates of hemorrhagic transformation and large infarction, and an increased proportion of severe DMVs (all p < 0.05). After adjusting for confounders, multivariable regression analysis showed that the severe DMVs grade (adjusted odds ratio [OR] = 5.830, 95% confidence interval [CI] = 1.266–26.856, p = 0.024) was significantly associated with three-month functional outcomes without interaction with other potential risk factors (p for interaction > 0.05). Conclusions: DMVs grade in the unaffected hemisphere was independently associated with three-month functional outcome in acute cardioembolic stroke patients. Patients with severe DMVs were more likely to have a poor functional outcome at three months.

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“…This retrospective study was based on a prospectively maintained database at our center from August 2013 to August 2017. 13 The inclusion criteria were (1) age of ≥18 years, (2) admission for acute ischemic stroke within 24 hours from symptom onset, (3) performance of emergency MRI (including SWI and diffusion-weighted imaging [DWI]) within 24 hours from symptom onset, (4) performance of DSA after MRI within 24 hours from symptom onset, and (5) DSA-confirmed M1 segment occlusion of the middle cerebral artery (including terminal T-shaped occlusion of the internal carotid artery). Patients with insufficient image quality were excluded.…”

Section: Methodsmentioning

confidence: 99%

Susceptibility-diffusion mismatch correlated with leptomeningeal collateralization in large vessel occlusion stroke

Jiang

Zhang²,

Pang

et al. 2021

J Int Med Res

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Objective To investigate the relationship between asymmetric prominent hypointense vessels (prominent vessel sign, PVS) on susceptibility-weighted imaging (SWI) and leptomeningeal collateralization in patients with acute ischemic stroke due to large vessel occlusion. Methods We retrospectively enrolled patients with M1 segment occlusion of the middle cerebral artery who underwent emergency magnetic resonance imaging and digital subtraction angiography within 24 hours from stroke onset. The extent of PVS on SWI was assessed using the Alberta Stroke Program Early CT Score (ASPECTS). Leptomeningeal collateralization on digital subtraction angiography images was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Spearman’s rank correlation test was performed to explore the correlation of ASITN/SIR scores with SWI-ASPECTS and SWI-diffusion-weighted imaging (DWI) mismatch scores. Results Thirty-five patients were enrolled. There was no significant correlation between SWI-ASPECTS and ASITN/SIR scores. However, SWI-DWI mismatch scores were positively correlated with ASITN/SIR scores. Conclusion The range of PVS on SWI did not closely reflect the collateral status, while the range of SWI-DWI mismatch was significantly correlated with the leptomeningeal collateralization. In patients with acute anterior circulation stroke due to large vessel occlusion, larger SWI-DWI mismatch was associated with better leptomeningeal collaterals.

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Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

Cited by 13 publications

References 25 publications

Additive Role of Susceptibility weighted image To Diffusion weighted image in the diagnosis Of Patients with Acute Stroke

Additive Role of Susceptibility weighted image To Diffusion weighted image in the diagnosis Of Patients with Acute Stroke

Association between Deep Medullary Veins in the Unaffected Hemisphere and Functional Outcome in Acute Cardioembolic Stroke: An Observational Retrospective Study

Susceptibility-diffusion mismatch correlated with leptomeningeal collateralization in large vessel occlusion stroke

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