Significance of Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging for Identification of Stroke Subtypes

Cho, Kyung Hee; Kim, Jong Seung; Kwon, Sun U.; Cho, A‐Hyun; Kang, Dong‐Wha

doi:10.1161/01.str.0000185932.73486.7a

Cited by 195 publications

(223 citation statements)

References 16 publications

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“…In this study, clots with a GRE SVS showed significantly lower IL‐1 β , TNF‐ α and MMP‐9 expression compared to clots without an SVS. These results support the idea that a GRE SVS is more frequently observed in patients with cardiogenic embolic stroke than in those with other stroke subtypes3, 12 and clots with a negative SVS could be associated with atherosclerosis 3, 13. The T2‐shortening effect of the intracellular deoxyhemoglobin component in red blood cells within the clot is the pathophysiologic basis of an SVS 3.…”

Section: Discussionsupporting

confidence: 82%

“…Paramagnetic intracellular deoxyhemoglobin leads to a nonuniform magnetic field causing marked signal loss on the GRE sequence because of spin dephasing. It was previously established that the presence of an SVS on GRE imaging was markedly associated with a higher red blood cell count in the clot, whereas fibrin‐dominant clots were associated with the absence of an SVS 3, 12. Fibrin‐dominant clots are typically formed because of endothelium injury overlies the complicated plaque in the setting of advanced atherosclerosis 13.…”

Section: Discussionmentioning

confidence: 99%

“…Conclusions regarding the presence or absence of an SVS on GRE imaging were reached by consensus. A positive SVS was defined as a hypointense signal change on GRE imaging within the occluded artery, and in cases of occlusion in the middle cerebral artery (MCA) or internal carotid‐T bifurcation, in which the diameter of the hypointense signals exceed that of the contralateral artery 11, 12. In cases of basilar artery occlusion, a positive SVS was defined as a hypointense signal within the prepontine cistern, in which the diameter of the hypointense signals exceeds the diameter of the parent basilar artery 17.…”

Section: Methodsmentioning

confidence: 99%

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Inflammatory mediator expression within retrieved clots in acute ischemic stroke

Baek

Kim

Yoon

et al. 2018

Ann Clin Transl Neurol

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ObjectiveIn this study we investigate the association between the expression of inflammatory mediators measured in clots retrieved by mechanical thrombectomy, stroke etiology, and the susceptibility vessel sign (SVS) on gradient‐echo (GRE) MR imaging in acute ischemic stroke patients.MethodsWe performed molecular analysis of intracranial clots retrieved by mechanical thrombectomy from 82 patients with acute stroke. Seventy‐two of these patients underwent GRE imaging before endovascular therapy. We measured the relative expression of inflammatory mediators by performing the quantitative real‐time polymerase chain reaction on the retrieved clots and assessed associations between the expression of inflammatory mediators and stroke subtypes as well as with GRE SVS.ResultsClassifications of stroke etiology for the cohort were as follows: cardioembolism (51, 62.2%), large artery atherosclerosis (9, 11%), and undetermined etiology (22, 26.8%). Clots associated with large artery atherosclerosis showed significantly higher interleukin (IL)‐1β expression than clots from both cardioembolism and undetermined etiology (P = 0.008). A positive SVS was identified in 48 of 72 patients (66.7%) who had GRE imaging. IL‐1β, tumor necrosis factor‐α, and matrix metalloproteinase‐9 expressions were significantly higher in clots with a negative SVS than in those with a positive SVS (P = 0.010, 0.049, and 0.004, respectively).InterpretationExpression of inflammatory mediators in intracranial clots differs significantly based on stroke etiology or presence or the absence of SVS on GRE imaging. This study suggests that molecular analysis of inflammatory mediators in retrieved clots is a promising tool for determining stroke mechanism in acute ischemic stroke patients.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Inflammatory mediator expression within retrieved clots in acute ischemic stroke

Baek

Kim

Yoon

et al. 2018

Ann Clin Transl Neurol

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“…Cho et al 33 found an association between pretreatment T2*-weighted gradient echo imaging-susceptibility vessel sign and subsequent recanalization in patients with large vessel occlusion; the assumption is that gradient echo imaging-susceptibility vessel sign predicts cardioembolic stroke and indicates fibrin-rich thrombi. In a post hoc analysis of this cohort, we rated the presence of gradient echo imaging-susceptibility vessel sign in patients with large vessel occlusion (N=66); 28% had gradient echo imaging-susceptibility vessel sign but we found no association with smoking status, stroke etiology, or subsequent recanalization.…”

Section: February 2013mentioning

confidence: 99%

Smoking-Thrombolysis Paradox

Kufner

Nolte²,

Galinović³

et al. 2013

Stroke

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Background and Purpose— The so-called smoking-thrombolysis paradox of an improved outcome after thrombolysis was first described in smokers with myocardial infarction. We investigated whether reperfusion rates and clinical outcome differ between smokers and nonsmokers with ischemic stroke after intravenous tissue plasminogen activator. Methods— Consecutive acute ischemic stroke patients, who had magnetic resonance imaging before and 1 day after thrombolysis, were included for analysis. All of the patients received intravenous tissue plasminogen activator within 4.5 hours. Reperfusion was defined as a 75% reduction in perfusion deficit (mean transit time >6 s) after thrombolysis compared with baseline. Magnetic resonance angiography was used to evaluate arterial stenosis and occlusion. Functional outcome was assessed 3 months after stroke using the modified Rankin Score. Results— Of 148 patients, 21.6% were smokers (n=32). Smokers were younger (median, 61 years [ SD , 9.4 years] versus 75 years [ SD , 11.6 years]; P <0.001), less often women (28% versus 51%; P =0.03), had lower baseline glucose levels (median, 6.2 mmol/L [interquartile range, 5.7–6.8 mmol/L] versus 6.7 mmol/L [interquartile range, 6.1–8.2 mmol/L]; P <0.01) and higher baseline perfusion deficits (median, 53 mL [interquartile range, 13–141 mL] versus 17 mL [interquartile range, 2–66 mL]; P =0.04). In a backward stepwise regression analysis including age, sex, hypertension, glucose, perfusion deficit, and smoking, smoking had an odds ratio of 4 (95% confidence interval, 1–16; P =0.03) for reperfusion and 6 (95% confidence interval, 1–30; P =0.05) for recanalization (regression analysis for recanalization also included localization of arterial occlusion). Smokers had a better outcome (modified Rankin Score=0–2) than nonsmokers (77% versus 55%; P =0.05). Conclusions— Smoking is independently associated with recanalization and reperfusion, indicating that thrombolytic therapy acts more effectively in smokers; because of small numbers, these results should be considered preliminary. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique Identifier: NCT00715533.

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“…4,5 The pathophysiologic basis for this sign in patients with an acute MCA occlusion is a T2-shortening effect of the intracellular deoxyhemoglobin component in erythrocytes within the clot. 4 Several researchers showed that the SVS was more commonly seen in red blood cell-dominant and mixed clots than in fibrin-dominant clots and could therefore reflect the composition of the clots.…”

mentioning

confidence: 99%

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

Kim¹,

Yoon²,

Heo³

et al. 2015

American Journal of Neuroradiology

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Significance of Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging for Identification of Stroke Subtypes

Cited by 195 publications

References 16 publications

Inflammatory mediator expression within retrieved clots in acute ischemic stroke

Inflammatory mediator expression within retrieved clots in acute ischemic stroke

Smoking-Thrombolysis Paradox

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

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