Skip to main content
SpringerLink
Log in

Peri-thrombus vascular hyperintensity sign: detection of intracranial thrombus location and length in acute ischemic stroke

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to investigate the diagnostic accuracy of peri-thrombus vascular hyperintensity sign (PVHS) on three-dimensional (3D) black-blood (BB) contrast-enhanced MRI for the detection of intracranial thrombus location and length in acute ischemic stroke (AIS) patients.

Materials and methods

Consecutive AIS patients who underwent MRI including 3D BB contrast-enhanced MRI sequence within 8 h of clinical onset were prospectively evaluated. Two readers independently reviewed the 3D BB contrast-enhanced MRI data to assess the presence and location of PVHS. Findings were compared with those of contrast-enhanced MR angiography (CE-MRA) as the reference standard.

Results

The PVHS was identified in 49% (63/129) of AIS patients with good agreement. The PVHS had 100% specificity, 88% negative predictive value, 89% sensitivity, and 100% positive predictive value for detection of acute arterial occlusions. Eight patients showed discordant thrombus locations between 3D BB contrast-enhanced MRI and CE-MRA. Median thrombus length in patients with complete occlusion was 9.61 mm.

Conclusion

The PVHS on 3D BB contrast-enhanced MRI is a highly specific tool for evaluating the location and length of a thrombus in AIS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.

    Article  CAS  Google Scholar 

  2. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.

    Article  Google Scholar 

  3. Borst J, Berkhemer OA, Santos EMM, et al. Value of thrombus CT characteristics in patients with acute ischemic stroke. Am J Neuroradiol. 2017;38(9):1758–64.

    Article  CAS  Google Scholar 

  4. Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316(12):1279.

    Article  Google Scholar 

  5. Le Bras A, Raoult H, Ferré JC, Ronzière T, Gauvrit JY. Optimal MRI sequence for identifying occlusion location in acute stroke: which value of time-resolved contrast-enhanced MRA? Am J Neuroradiol. 2015;36(6):1081–8.

    Article  Google Scholar 

  6. Stock KW, Wetzel S, Kirsch E, Bongartz G, Steinbrich W, Radue EW. Anatomic evaluation of the circle of Willis: MR angiography versus intraarterial digital subtraction angiography. AJNR Am J Neuroradiol. 1996;17(8):1495–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Diouf A, Fahed R, Gaha M, et al. Cervical internal carotid occlusion versus pseudo-occlusion at CT angiography in the context of acute stroke: an accuracy, interobserver, and intraobserver agreement study. Radiology. 2018;286(3):1008–155.

    Article  Google Scholar 

  8. Boujan T, Neuberger U, Pfaff J, et al. Value of contrast-enhanced MRA versus time-of-flight MRA in acute ischemic stroke MRI. AJNR Am J Neuroradiol. 2018;39(9):1710–6.

    Article  CAS  Google Scholar 

  9. Chen Z, Zhang M, Shi F, et al. Pseudo-occlusion of the internal carotid artery predicts poor outcome after reperfusion therapy. Stroke. 2018;49(5):1204–9.

    Article  Google Scholar 

  10. Park M, Oh S, Baik SK, Jung DS, Park K. Susceptibility-weighted imaging for detection of thrombus in acute cardioembolic stroke. J Stroke. 2016;18(1):73–9.

    Article  Google Scholar 

  11. Liebeskind DS, Sanossian N, Yong WH, et al. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke. 2011;42(5):1237–43.

    Article  Google Scholar 

  12. Rovira A, Orellana P, Alvarez-Sabín J, et al. Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology. 2004;232(2):466.

    Article  Google Scholar 

  13. Flacke S, Urbach H, Keller E, et al. Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology. 2000;215(2):476.

    Article  CAS  Google Scholar 

  14. Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J. The use and pitfalls of intracranial vessel wall imaging: how we do it. Radiology. 2018;286(1):12–28.

    Article  Google Scholar 

  15. Mandell DM, Mossa-Basha M, Qiao Y, et al. Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. Am J Neuroradiol. 2017;38(2):218–29.

    Article  CAS  Google Scholar 

  16. Mossa-Basha M, Shibata DK, Hallam DK, et al. Added value of vessel wall magnetic resonance imaging for differentiation of nonocclusive intracranial vasculopathies. Stroke. 2017;48(11):3026–33.

    Article  Google Scholar 

  17. Lee JS, Demchuk AM. Choosing a hyperacute stroke imaging protocol for proper patient selection and time efficient endovascular treatment: lessons from recent trials. J Stroke. 2015;17(3):221–8.

    Article  Google Scholar 

  18. Renú A, Laredo C, Lopez-Rueda A, et al. Vessel wall enhancement and blood-cerebrospinal fluid barrier disruption after mechanical thrombectomy in acute ischemic stroke. Stroke. 2017;48(3):651–7.

    Article  Google Scholar 

  19. Niu P, Yu Y, Zhou H, et al. Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging. Sci Rep UK. 2016;6(1):38534.

    Article  CAS  Google Scholar 

  20. Jang W, Kwak HS, Chung GH, Hwang SB. Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke. Eur Radiol. 2018;28(9):3840–7.

    Article  Google Scholar 

  21. Obara M, Kuroda K, Wang J, et al. Comparison between two types of improved motion-sensitized driven-equilibrium (iMSDE) for intracranial black-blood imaging at 3.0 tesla. J Magn Reson Imaging. 2014;40(4):824–31.

    Article  Google Scholar 

  22. Grossberg JA, Haussen DC, Cardoso FB, et al. Cervical carotid pseudo-occlusions and false dissections. Stroke. 2017;48(3):774–7.

    Article  Google Scholar 

  23. Korn A, Bender B, Brodoefel H, et al. Grading of carotid artery stenosis in the presence of extensive calcifications: dual-energy CT angiography in comparison with contrast-enhanced MR angiography. Clin Neuroradiol. 2015;25(1):33–40.

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported in part by the National Natural Science Foundation of China (No. 81601459).

Author information

Author notes

  1. Qian Chen and Wei Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China

    Qian Chen, Yu-Chen Chen, Guozhong Chen, Danfeng Zhang & Xin-dao Yin

  2. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China

    Wei Wang & Junshan Zhou

  3. Department of Radiology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

    Ling Ni

Authors
  1. Qian Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Chen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guozhong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ling Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danfeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Junshan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xin-dao Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xin-dao Yin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol of this study was reviewed and approved by our Institutional Ethics Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Q., Wang, W., Chen, YC. et al. Peri-thrombus vascular hyperintensity sign: detection of intracranial thrombus location and length in acute ischemic stroke. Jpn J Radiol 38, 516–523 (2020). https://doi.org/10.1007/s11604-020-00937-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-020-00937-1

Keywords

Search

Navigation