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Clinical Neuroradiology

, Volume 26, Issue 3, pp 317–323 | Cite as

Is the Susceptibility Vessel Sign on 3-Tesla Magnetic Resonance T2*-Weighted Imaging a Useful Tool to Predict Recanalization in Intravenous Tissue Plasminogen Activator?

  • N. Yamamoto
  • J. Satomi
  • M. Harada
  • Y. Izumi
  • S. Nagahiro
  • R. Kaji
Original Article

Abstract

The aim of this study was to investigate the independent factors associated with the absence of recanalization approximately 24 h after intravenous administration of tissue-type plasminogen activator (IV TPA). The previous studies have been conducted using 1.5-Tesla (T) magnetic resonance imaging (MRI). We studied whether the characteristics of 3-T MRI findings were useful to predict outcome and recanalization after IV tPA. Patients with internal carotid artery (ICA) or middle cerebral artery (MCA) (horizontal portion, M1; Sylvian portion, M2) occlusion and treated by IV tPA were enrolled. We studied whether the presence of susceptibility vessel sign (SVS) at M1 and low clot burden score on T2*-weighted imaging (T2*-CBS) on 3-T MRI were associated with the absence of recanalization. A total of 49 patients were enrolled (27 men; mean age, 73.9 years). MR angiography obtained approximately 24 h after IV tPA revealed recanalization in 21 (42.9 %) patients. Independent factors associated with the absence of recanalization included ICA or proximal M1 occlusion (odds ratio, 69.6; 95 % confidence interval, 5.05–958.8, p = 0.002). In this study, an independent factor associated with the absence of recanalization may be proximal occlusion of the cerebral arteries rather than SVS in the MCA or low T2*-CBS on 3-T MRI.

Keywords

3-Tesla MRI T2*-WI tPA Recanalization 

References

  1. 1.
    Ringelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PN, Thron A. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology. 1992;42:289–98.CrossRefPubMedGoogle Scholar
  2. 2.
    Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011;42:1775–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Kimura K, Sakamoto Y, Aoki J, Iguchi Y, Shibazaki K, Inoue T. Clinical and MRI predictors of no early recanalization within 1 hour after tissue-type plasminogen activator administration. Stroke. 2011;42:3150–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Moftakhar P, English JD, Cooke DL, Kim WT, Stout C, Smith WS, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Density of thrombus on admission CT predicts revascularization efficacy in large vessel occlusion acute ischemic stroke. Stroke. 2013;44:243–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Legrand L, Naggara O, Turc G, Mellerio C, Roca P, Calvet D, Labeyrie MA, Baron JC, Mas JL, Meder JF, Touzé E, Oppenheim C. Clot burden score on admission T2*-MRI predicts recanalization in acute stroke. Stroke. 2013;44:1878–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Derex L, Hermier M, Adeleine P, Pialat JB, Wiart M, Berthezène Y, Froment JC, Trouillas P, Nighoghossian N. Influence of the site of arterial occlusion on multiple baseline hemodynamic MRI parameters and post-thrombolytic recanalization in acute stroke. Neuroradiology. 2004;46:883–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Rubiera M, Ribo M, Delgado-Mederos R, Santamarina E, Delgado P, Montaner J, Alvarez-Sabín J, Molina CA. Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke. 2006;37:2301–5.CrossRefPubMedGoogle Scholar
  8. 8.
    De Silva DA, Brekenfeld C, Ebinger M, Christensen S, Barber PA, Butcher KS, Levi CR, Parsons MW, Bladin CF, Donnan GA, Davis SM; Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) Investigators. The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Stroke. 2010;41:295–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Puetz V, Dzialowski I, Hill MD, Ubramaniam S, Sylaja PN, Krol A, O’Reilly C, Hudon ME, Hu WY, Coutts SB, Barber PA, Watson T, Roy J, Demchuk AM; Calgary CTA Study Group. Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Int J Stroke. 2008;3:230–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009;30:525–31.CrossRefPubMedGoogle Scholar
  11. 11.
    Chakeres DW, Abduljalil AM, Novak P, Novak V. Comparison of 1.5 and 8 T high-resolution magnetic resonance imaging of lacunar infarcts. J Comput Assist Tomogr. 2002;26:628–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Lauzon ML, Sevick RJ, Demchuk AM, Frayne R. Stroke imaging at 3.0 T. Neuroimaging Clin N Am. 2006;16:343–66, xii.CrossRefPubMedGoogle Scholar
  13. 13.
    Atlas SW, Mark AS, Grossman RI, Gomori JM. Intracranial hemorrhage: gradient-echo MR imaging at 1.5 T. Comparison with spin-echo imaging and clinical applications. Radiology. 1988;168:803–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Mori E, Minematsu K, Nakagawara J, Yamaguchi T, Sasaki M, Hirano T. Effects of 0.6 mg/kg intravenous alteplase on vascular and clinical outcomes in middle cerebral artery occlusion: Japan Alteplase Clinical Trial II (J-ACT II). Stroke. 2010;41:461–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.CrossRefPubMedGoogle Scholar
  16. 16.
    Cronin CA. Intravenous tissue plasminogen activator for stroke: a review of the ECASS III results in relation to prior clinical trials. J Emerg Med. 2010;38:99–105.CrossRefPubMedGoogle Scholar
  17. 17.
    Hirano T, Sasaki M, Mori E, Minematsu K, Nakagawara J, Yamaguchi T. Residual vessel length on magnetic resonance angiography identifies poor responders to alteplase in acute middle cerebral artery occlusion patients: exploratory analysis of the Japan Alteplase Clinical Trial II. Stroke. 2010;41:2828–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Flacke S, Urbach H, Keller E, Träber F, Hartmann A, Textor J, Gieseke J, Block W, Folkers PJ, Schild HH. Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology. 2000;215:476–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Rovira A, Orellana P, Alvarez-Sabin J, Arenillas JF, Aymerich X, Grivé E, Molina C, Rovira-Gols A. Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology. 2004;232:466–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM; Microbleed Study Group. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8:165–74.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Scheid R, Ott DV, Roth H, Schroeter ML, von Cramon DY. Comparative magnetic resonance imaging at 1.5 and 3 Tesla for the evaluation of traumatic microbleeds. J Neurotrauma. 2007;24(12):1811–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Weisstanner C, Gratz PP, Schroth G, Arenillas JF, Aymerich X, Grivé E, Molina C, Rovira-Gols A, Verma RK, Köchl A, Jung S, Arnold M, Gralla J, Zubler C, Hsieh K, Mordasini P, El-Koussy M. Thrombus imaging in acute stroke: correlation of thrombus length on susceptibility-weighted imaging with endovascular reperfusion success. Eur Radiol. 2014;24:1735–41.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • N. Yamamoto
    • 1
  • J. Satomi
    • 2
  • M. Harada
    • 3
  • Y. Izumi
    • 1
  • S. Nagahiro
    • 2
  • R. Kaji
    • 1
  1. 1.Department of Clinical Neurosciences, Institute of Health BiosciencesThe University of Tokushima Graduate SchoolTokushimaJapan
  2. 2.Department of Neurosurgery, Institute of Health BiosciencesTokushima UniversityTokushimaJapan
  3. 3.Department of Radiology, Institute of Health BiosciencesTokushima UniversityTokushimaJapan

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