Abstract
Background
Multiple prominent hypointense vessels on susceptibility-weighted image (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. SWI is suitable for venous imaging.
Purpose
To evaluate the conditions of prominent hypointense vessel (PHV) in hyperacute and acute cerebral infarctions using susceptibility-weighted image (SWI).
Materials and methods
Magnetic resonance images, including SWI, of 284 patients with acute infarction were evaluated. Based on lesion size, the infarction was classified as a small (< 3 cm) or a large (> 3 cm) infarction. Stage of infarction was classified as hyperacute (< 6 h) or acute (> 6 h, < 1 week) on the basis of the onset of stroke. The site of infarction was categorised as a deep grey matter or a mixed (cortical and/or deep grey matter) infarction. The venous structures were analysed qualitatively for the calibre difference between ipsilateral and contralateral hemispheres.
We quantitatively analysed the relationship between the size of areas with PHV on SWI and the abnormalities on MR angiography, apparent diffusion coefficient value, and signal intensity on T2WI in the 271 patients.
Results
PHV over the infarction site was observed in 54.1% (137/253) of the large infarctions, and 19.3% (6/31) of the small infarctions on SWI. PHV was demonstrated in 63.1% (118/187) of mixed infarctions and 25.8% (25/97) of deep grey matter infarctions, and 59.2% (58/98) in hyperacute and 45.7% (85/186) of acute infarctions. The presence of PHV was statistically significant in the size and region of cerebral infarction (p < 0.05), and was not significant in the stage of infarction (p = 0.137). Quantitative analysis revealed significant differences in the MRA abnormalities and ADC values in the PHV ( +) group (p < 0.05) and no significant difference in the T2WI SI ratio in the PHV ( +) group (p = 0.086), compared with PHV (−) group.
Conclusion
PHV on SWI was more prominent at the portions with the large and mixed infarctions. PHV was observed both in hyperacute and acute infarction.
Similar content being viewed by others
References
Reichenbach JR, Venkatesan R, Schillinger DJ, Kido DK, Haacke EM. Small vessels in the human brain: MR venography with deoxyhemoglobin as an intrinsic contrast agent. Radiology. 1997;204(1):272–7.
Rauscher A, Sedlacik J, Barth M, Mentzel H, Reichenbach JR. Magnetic susceptibility-weighted MR phase imaging of the human brain. Am J Neuroradiol. 2005;26(4):736–42.
Lee BC, Vo KD, Kido DK, Mukherjee P, Reichenbach J, Lin W, et al. MR high-resolution blood oxygenation level-dependent venography of occult (low-flow) vascular lesions. Am J Neuroradiol. 1999;20(7):1239–42.
Barth M, Nobauer-Huhmann IM, Reichenbach JR, Mlynárik V, Schöggl A, Matula C, et al. High-resolution three-dimensional contrast-enhanced blood oxygenation level-dependent magnetic resonance venography of brain tumors at 3 Tesla: first clinical experience and comparison with 1.5 Tesla. Invest Radiol. 2003;38(7):409–14.
Powers WJ. Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol. 1991;29(3):231–40.
Hermier M, Nighoghossian N. Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke. 2004;35(8):1989–94.
Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj A, Kapilamoorthy TR. Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol. 2009;64(1):74–83.
Kesavadas C, Santhosh K, Thomas B. Susceptibility weighted imaging in cerebral hypoperfusion-can we predict increased oxygen extraction fraction? Neuroradiology. 2010;52(11):1047–54.
Baik SK, Choi W, Oh SJ, Park K, Park M, Yang TI, et al. Change in cortical vessel signs on susceptibility-weighted images after full recanalization in hyperacute ischemic stroke. Cerebrovasc Dis. 2012;34(3):206–12.
Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: technical aspects and clinical applications, part 2. Am J Neuroradiol. 2009;30(2):232–52.
Mammen EF. Pathogenesis of venous thrombosis. Chest. 1992;102(6 Suppl):640S-644S.
Tong KA, Ashwal S, Obenaus A, Nickerson JP, Kido D, Haacke EM. Susceptibility-weighted MR imaging: a review of clinical applications in children. Am J Neuroradiol. 2008;29(1):9–17.
Roussel SA, van Bruggen N, King MD, Gadian DG. Identification of collaterally perfused areas following focal cerebral ischemia in the rat by comparison of gradient echo and diffusion-weighted MRI. J Cereb Blood Flow Metab. 1995;15(4):578–86.
Pozzilli C, Itoh M, Matsuzawa T, Fukuda H, Abe Y, Sato T, et al. Positron emission tomography in minor ischemic stroke using oxygen-15 steady-state technique. J Cereb Blood Flow Metab. 1987;7(2):137–42.
Cordes M, Henkes H, Roll D, Eichstädt H, Christe W, Langer M, et al. Subacute and chronic cerebral infarctions: SPECT and gadolinium-DTPA enhanced MR imaging. J Comput Assist Tomogr. 1989;13(4):567–71.
Toyama H, Takeshita G, Takeuchi A, Anno H, Ejiri K, Maeda H, et al. Cerebral hemodynamics in patients with chronic obstructive carotid disease by rCBF, rCBV, and rCBV/rCBF ratio using SPECT. J Nucl Med. 1990;31(1):55–60.
Martin WR, Baker RP, Grubb RL, Raichle ME. Cerebral blood volume, blood flow, and oxygen metabolism in cerebral ischaemia and subarachnoid haemorrhage: an in-vivo study using positron emission tomography. Acta Neurochir (Wien). 1984;70(1–2):3–9.
Wang Y, Shi T, Chen B, Lin G, Xu Y, Geng Y. Prominent hypointense vessel sign on susceptibility-weighted imaging is associated with clinical outcome in acute ischaemic stroke. Eur Neurol. 2018;79(5–6):231–9.
Zhang X, Zhang S, Chen Q, Ding W, Campbell BCV, Lou M. Ipsilateral prominent thalamostriate vein on susceptibility-weighted imaging predicts poor outcome after intravenous thrombolysis in acute ischemic stroke. Am J Neuroradiol. 2017;38(5):875–81.
Chen CY, Chen CI, Tsai FY, Tsai PH, Chan WP. Prominent vessel sign on susceptibility-weighted imaging in acute stroke: prediction of infarct growth and clinical outcome. PLoS ONE. 2015;10(6):e0131118.
Wu X, Luo S, Wang Y, Chen Y, Liu J, Bai J, et al. Use of susceptibility-weighted imaging in assessing ischemic penumbra: a case report. Medicine (Baltimore). 2017;96(6):e6091.
Darwish EAF, Abdelhameed-El-Nouby M, Geneidy E. Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging. Insights Imaging. 2020;11(1):6.
Mukherjee P, Kang HC, Videen TO, McKinstry RC, Powers WJ, Derdeyn CP. Measurement of cerebral blood flow in chronic carotid occlusive disease: comparison of dynamic susceptibility contrast perfusion MR imaging with positron emission tomography. Am J Neuroradiol. 2003;24(5):862–71.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest that could influence this study.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board.
Informed consent
The requirement of written informed consent was waived due to the retrospective nature of 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
Cite this article
Kim, YW., Choi, Y.Y., Park, S.Y. et al. Prominent hypointense vessel on susceptibility-weighted images accompanying hyperacute and acute large infarction. Jpn J Radiol 39, 681–689 (2021). https://doi.org/10.1007/s11604-021-01107-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-021-01107-7