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01.06.2020 | Original Article

Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus

verfasst von: Javier M. Romero, Afonso C. P. Liberato, Daniel Montes, Isabelle Barnaure, Jing Xu, Noor Maza, Ramon G. Gonzalez

Erschienen in: Emergency Radiology | Ausgabe 3/2020

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Abstract

Purpose

Rapid detection of vessel occlusion is pivotal to the management of patients with acute stroke. Magnetic resonance (MR) T2*-weighted (W) sequence has proven its capability to detect intravascular thrombi, but its diagnostic value compared to computed tomography angiography (CTA) is not well established. We aimed to determine the diagnostic performance of fast 1.5-T MR T2*W sequences compared to CTA for the detection of intra-arterial thrombi in patients with acute stroke.

Methods

About 71 consecutive patients with known middle cerebral artery (MCA) territory stroke were identified. Patients with CTA and MR imaging within 12 h of symptom onset were included in the study. Two investigators reviewed the DWI and T2*W sequences for the presence of infarction and susceptibility vessel sign (SVS). A comparison to the corresponding internal carotid artery (ICA) and M1 and M2 segments of the MCA findings on CTA was made.

Results

Of the 51 patients included in our study, CTA thrombi were identified 84% patients (43/51). Of these, 77% (33/43) presented a corresponding SVS on T2*W. A total of 29 CTA thrombi were identified in the M1 segment, and of these, 22 patients had a corresponding SVS. Of the patients without M1 thrombus on CTA, no M1-SVS was detected on T2*W sequences. We found an accuracy of 92%, sensitivity of 85%, specificity of 100%, PPV 100%, and NPV of 86% for M1 occlusion. The Kappa coefficient was 0.79.

Conclusion

Fast T2*W sequences demonstrated very good diagnostic performance and inter-reader agreement for detecting SVS in the M1 segment in patients with acute ischemic stroke.

Gasparian G, Sanossian N, Shiroishi M, Liebeskind D (2015) Imaging of occlusive thrombi in acute ischemic stroke. Int J Stroke 10:298–305. https://doi.org/10.1111/ijs.12435 CrossRefPubMed

Derex L, Nighoghossian N, Hermier M et al (2002) Early detection of cerebral arterial occlusion on magnetic resonance angiography: predictive value of the baseline NIHSS score and impact on neurological outcome. Cerebrovasc Dis 13:225–229. https://doi.org/10.1159/000057847 CrossRefPubMed

Schellinger PD, Fiebach JB, Jansen O, Ringleb PA, Mohr A, Steiner T, Heiland S, Schwab S, Pohlers O, Ryssel H, Orakcioglu B, Sartor K, Hacke W (2001) Stroke magnetic resonance imaging within 6 hours after onset of hyperacute cerebral ischemia. Ann Neurol 49:460–469CrossRef

González RG (2012) Clinical MRI of acute ischemic stroke. J Magn Reson Imaging 36:259–271. https://doi.org/10.1002/jmri.23595 CrossRefPubMedPubMedCentral

Nael K, Khan R, Choudhary G, Meshksar A, Villablanca P, Tay J, Drake K, Coull BM, Kidwell CS (2014) Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke 45:1985–1991. https://doi.org/10.1161/STROKEAHA.114.005305 CrossRefPubMed

Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj K, Kapilamoorthy TR (2009) Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol 64:74–83. https://doi.org/10.1016/j.crad.2008.04.022 CrossRefPubMed

González RG, Schaefer PW, Buonanno FS, Schwamm LH, Budzik RF, Rordorf G, Wang B, Sorensen AG, Koroshetz WJ (1999) Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology 210:155–162. https://doi.org/10.1148/radiology.210.1.r99ja02155 CrossRefPubMed

Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG (2002) CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 224:353–360. https://doi.org/10.1148/radiol.2242010873 CrossRefPubMed

Simonsen CZ, Madsen MH, Schmitz ML, Mikkelsen IK, Fisher M, Andersen G (2015) Sensitivity of diffusion- and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%. Stroke 46:98–101. https://doi.org/10.1161/STROKEAHA.114.007107 CrossRefPubMed

10.

Schellinger PD, Thomalla G, Fiehler J et al (2007) MRI-based and CT-based thrombolytic therapy in acute stroke within and beyond established time windows: an analysis of 1210 patients. Stroke 38:2640–2645. https://doi.org/10.1161/STROKEAHA.107.483255 CrossRefPubMed

11.

Gerischer LM, Fiebach JB, Scheitz JF, Audebert HJ, Endres M, Nolte CH (2013) Magnetic resonance imaging-based versus computed tomography-based thrombolysis in acute ischemic stroke: comparison of safety and efficacy within a cohort study. Cerebrovasc Dis 35:250–256. https://doi.org/10.1159/000347071 CrossRefPubMed

12.

Rovira A, Orellana P, Alvarez-Sabín J, Arenillas JF, Aymerich X, Grivé E, Molina C, Rovira-Gols A (2004) Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology 232:466–473. https://doi.org/10.1148/radiol.2322030273 CrossRefPubMed

13.

Shah S, Luby M, Poole K, Morella T, Keller E, Benson RT, Lynch JK, Nadareishvili Z, Hsia AW (2015) Screening with MRI for accurate and rapid stroke treatment: SMART. Neurology 84:2438–2444. https://doi.org/10.1212/WNL.0000000000001678 CrossRefPubMedPubMedCentral

14.

Payabvash S, Benson JC, Taleb S et al (2017) Susceptible vessel sign: identification of arterial occlusion and clinical implications in acute ischaemic stroke. Clin Radiol 72:116–122. https://doi.org/10.1016/j.crad.2016.11.001 CrossRefPubMed

15.

Hayman LA, Taber KH, Ford JJ, Saleem A, Gurgun M, Mohamed S, Bryan RN (1989) Effect of clot formation and retraction on spin-echo MR images of blood: an in vitro study. AJNR Am J Neuroradiol 10:1155–1158PubMed

16.

Bradley WG (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26. https://doi.org/10.1148/radiology.189.1.8372185 CrossRef

17.

Naggara O, Raymond J, Ayllon MD et al (2013) T2* “susceptibility vessel sign” demonstrates clot location and length in acute ischemic stroke. PLoS One 8:e76727. https://doi.org/10.1371/journal.pone.0076727 CrossRefPubMedPubMedCentral

18.

Chalela JA, Haymore JB, Ezzeddine MA et al (2002) The hypointense MCA sign. Neurology 58:1470CrossRef

19.

Bourcier R, Volpi S, Guyomarch B et al (2015) Susceptibility vessel sign on MRI predicts favorable clinical outcome in patients with anterior circulation acute stroke treated with mechanical thrombectomy. Am J Neuroradiol. https://doi.org/10.3174/ajnr.A4483

20.

Chang J, Arani K, Chew S, Frosch MP, Gonzalez RG, Maza N, Romero JM (2017) Susceptibility etching on MRI in patients with microangiopathy. J Neuroimaging 27:43–49. https://doi.org/10.1111/jon.12384 CrossRefPubMed

21.

Assouline E, Benziane K, Reizine D, Guichard JP, Pico F, Merland JJ, Bousser MG, Chabriat H (2005) Intra-arterial thrombus visualized on T2* gradient echo imaging in acute ischemic stroke. Cerebrovasc Dis 20:6–11. https://doi.org/10.1159/000086120 CrossRefPubMed

22.

Allibert R, Billon Grand C, Vuillier F, Cattin F, Muzard E, Biondi A, Moulin T, Medeiros E (2014) Advantages of susceptibility-weighted magnetic resonance sequences in the visualization of intravascular thrombi in acute ischemic stroke. Int J Stroke 9:980–984. https://doi.org/10.1111/ijs.12373 CrossRefPubMed

23.

Hodel J, Leclerc X, Khaled W, Tamazyan R, Rodallec M, Gerber S, Blanc R, Benadjaoud M, Lambert O, Rabrait C, Zuber M, Rahmouni A, Zins M (2014) Comparison of 3D multi-echo gradient-echo and 2D T2* MR sequences for the detection of arterial thrombus in patients with acute stroke. Eur Radiol 24:762–769. https://doi.org/10.1007/s00330-013-3061-1 CrossRefPubMed

24.

Flacke S, Urbach H, Keller E et al (2000) Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology 215:476–482. https://doi.org/10.1148/radiology.215.2.r00ma09476 CrossRefPubMed

25.

Agarwal A, Vijay K, Thamburaj K, Kanekar S, Kalapos P (2014) Sensitivity of 3D gradient recalled echo susceptibility-weighted imaging technique compared to computed tomography angiography for detection of middle cerebral artery thrombus in acute stroke. Neurol Int 6:5521. https://doi.org/10.4081/ni.2014.5521 CrossRefPubMedPubMedCentral

26.

Lingegowda D, Thomas B, Vaghela V, Hingwala DR, Kesavadas C, Sylaja PN (2012) “Susceptibility sign” on susceptibility-weighted imaging in acute ischemic stroke. Neurol India 60:160–164. https://doi.org/10.4103/0028-3886.96389 CrossRefPubMed

27.

Bash S, Villablanca JP, Jahan R et al (2005) Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol 26:1012–1021PubMed

28.

Hiai Y, Kakeda S, Sato T, Ohnari N, Moriya J, Kitajima M, Hirai T, Yamashita Y, Korogi Y (2008) 3D TOF MRA of intracranial aneurysms at 1.5 T and 3 T. Acad Radiol 15:635–640. https://doi.org/10.1016/j.acra.2007.12.021 CrossRefPubMed

29.

Regier DA, Narrow WE, Clarke DE et al (2013) DSM-5 field trials in the United States and Canada, part II: test-retest reliability of selected categorical diagnoses. AJP 170:59–70. https://doi.org/10.1176/appi.ajp.2012.12070999 CrossRef

30.

Bader MK, Palmer S (2006) What’s the “hyper” in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours. AACN Adv Crit Care 17:194–214CrossRef

31.

Schellinger PD, Chalela JA, Kang D-W, Latour LL, Warach S (2005) Diagnostic and prognostic value of early MR imaging vessel signs in hyperacute stroke patients imaged <3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 26:618–624PubMed

32.

Haacke EM, Xu Y, Cheng Y-CN, Reichenbach JR (2004) Susceptibility weighted imaging (SWI). Magn Reson Med 52:612–618. https://doi.org/10.1002/mrm.20198 CrossRefPubMed

33.

Soman S, Holdsworth SJ, Barnes PD, Rosenberg J, Andre JB, Bammer R, Yeom KW (2013) Improved T2* imaging without increase in scan time: SWI processing of 2D gradient Echo. Am J Neuroradiol 34:2092–2097. https://doi.org/10.3174/ajnr.A3595 CrossRefPubMed

34.

Menon BK, Campbell Bruce CV, Christopher L, Mayank G (2015) Role of imaging in current acute ischemic stroke workflow for endovascular therapy. Stroke 46:1453–1461. https://doi.org/10.1161/STROKEAHA.115.009160 CrossRefPubMed

35.

Kim HS, Lee DH, Choi CG, Kim SJ, Suh DC (2006) Progression of middle cerebral artery susceptibility sign on T2*-weighted images: its effect on recanalization and clinical outcome after thrombolysis. AJR Am J Roentgenol 187:W650–W657. https://doi.org/10.2214/AJR.05.0447 CrossRefPubMed

36.

Kimura K, Iguchi Y, Shibazaki K, Watanabe M, Iwanaga T, Aoki J (2009) M1 susceptibility vessel sign on T2* as a strong predictor for no early recanalization after IV-t-PA in acute ischemic stroke. Stroke 40:3130–3132. https://doi.org/10.1161/STROKEAHA.109.552588 CrossRefPubMed

37.

Shinohara Y, Kinoshita T, Kinoshita F (2012) Changes in susceptibility signs on serial T2*-weighted single-shot echo-planar gradient-echo images in acute embolic infarction: comparison with recanalization status on 3D time-of-flight magnetic resonance angiography. Neuroradiology 54:427–434. https://doi.org/10.1007/s00234-011-0895-6 CrossRefPubMed

38.

Legrand L, Naggara O, Turc G, Mellerio C, Roca P, Calvet D, Labeyrie MA, Baron JC, Mas JL, Meder JF, Touzé E, Oppenheim C (2013) Clot burden score on admission T2*-MRI predicts recanalization in acute stroke. Stroke 44:1878–1884. https://doi.org/10.1161/STROKEAHA.113.001026 CrossRefPubMed

39.

Cho Y-H, Park H-S, Choi J-H et al (2014) Diagnostic value of thrombus size on T2*-weighted gradient echo imaging in acute middle cerebral artery occlusion. J Cerebrovasc Endovasc Neurosurg 16:85–92. https://doi.org/10.7461/jcen.2014.16.2.85 CrossRefPubMedPubMedCentral

40.

Aoki J, Kimura K, Shibazaki K et al (2013) Location of the susceptibility vessel sign on T2*-weighted MRI and early recanalization within 1 hour after tissue plasminogen activator administration. CEE 3:111–120. https://doi.org/10.1159/000354848 CrossRef

41.

Derraz I, Bourcier R, Soudant M et al (2019) Does clot burden score on baseline T2*-MRI impact clinical outcome in acute ischemic stroke treated with mechanical Thrombectomy? J Stroke 21:91–100. https://doi.org/10.5853/jos.2018.01921 CrossRefPubMedPubMedCentral

42.

Taber KH, Hayman LA, Herrick RC, Kirkpatrick JB (1996) Importance of clot structure in gradient-echo magnetic resonance imaging of hematoma. J Magn Reson Imaging 6:878–883. https://doi.org/10.1002/jmri.1880060607 CrossRefPubMed

43.

Yan S, Liu K, Tong L, Yu Y, Zhang S, Lou M (2016) Different risk factors for poor outcome between patients with positive and negative susceptibility vessel sign. J Neurointerv Surg 8:1001–1005. https://doi.org/10.1136/neurintsurg-2015-011999 CrossRefPubMed

44.

Liang L, Korogi Y, Sugahara T, Shigematsu Y, Okuda T, Ikushima I, Takahashi M (1999) Detection of intracranial hemorrhage with susceptibility-weighted MR sequences. Am J Neuroradiol 20:1527–1534PubMed

Titel: Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus
verfasst von: Javier M. Romero
Afonso C. P. Liberato
Daniel Montes
Isabelle Barnaure
Jing Xu
Noor Maza
Ramon G. Gonzalez
Publikationsdatum: 01.06.2020
Verlag: Springer International Publishing
Erschienen in: Emergency Radiology / Ausgabe 3/2020
Print ISSN: 1070-3004
Elektronische ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-020-01754-9

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Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus