J Korean Soc Magn Reson Med.  2011 Dec;15(3):257-261. 10.13104/jksmrm.2011.15.3.257.

A newly Developed Hyperintensity Within a Posterior Cerebral Artery Susceptibility Vessel Sign in T2*-Weighted Gradient-Echo Imaging: a Case Report and Correlation with Magnetic Resonance Angiography and Black-Blood Imaging

• Youn SW
• Kim HK

• KMID: 2000055
• DOI: http://doi.org/10.13104/jksmrm.2011.15.3.257

Abstract

The susceptibility vessel sign (SVS) on T2*-weighted gradient-echo imaging (T2*-GRE) is useful for detecting intra-arterial clots and monitoring the response to thrombolysis. SVS-GRE was observed in a 52-year-old man with acute occlusion of the posterior cerebral artery (PCA) before and after failed intra-arterial thrombolysis. One-week follow-up T2*-GRE revealed a hyperintensity within the SVS-GRE in the affected PCA. The right PCA remained occluded on time-of-flight (TOF) magnetic resonance angiography (MRA), but its P2 segment exhibited luminal patency on contrast-enhanced (CE) MRA. Black-blood MR imaging using a T1-weighted turbo-spin echo sequence revealed narrowing of the arterial lumen and thickening of the wall due to an atherosclerotic plaque. The observations from TOF-MRA, CE-MRA, and black-blood MR imaging suggest that a newly developed hyperintensity within the SVS-GRE seems to be associated with slow flow through a severe atherosclerotic stenosis or near-occlusion.

Keyword

Hyperintensity; Susceptibility vessel sign; T2*-weighted gradient echo MR imaging; Slow flow; Stenosis

MeSH Terms

Constriction, Pathologic
Follow-Up Studies
Glycosaminoglycans
Humans
Magnetic Resonance Angiography
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Middle Aged
Passive Cutaneous Anaphylaxis
Phenobarbital
Plaque, Atherosclerotic
Posterior Cerebral Artery
Glycosaminoglycans
Phenobarbital

Figure

• 

  Fig. 1 A 52-year-old man presented with sudden vision loss and vertigo. (a) Baseline T2*-weighted gradient-echo imaging (T2*-GRE). The susceptibility asymmetry index (SAI), defined as the diameter ratio between the susceptibility vessel sign (SVS) on T2*-GRE and the contralateral normal posterior cerebral artery (PCA) on magnetic resonance angiography (MRA), was 1.11 (arrows; diameter of the SVS-GRE, 3.65 mm). (b) Baseline digital subtraction angiography (DSA) showed complete occlusion at the junction of the right P1 and P2 segments. (c) DSA performed after intra-arterial thrombolysis revealed failed recanalization. (d) The SAI on T2*-GRE immediately after failed thrombolysis was 0.94 (arrows; diameter of the SVS-GRE, 3.10 mm).

• 

  Fig. 2 One-week follow-up MR imaging. (a) T2*-GRE showed a newly developed hyperintensity within the susceptibility vessel sign (arrows; SAI, 1.60; diameter, 5.24 mm). (b) Time-of-flight MRA showed occlusion of the right P2 segment of the PCA (arrows). (c) Raw data of contrast-enhanced MRA obtained in the coronal plane revealed tubular narrowing of the vascular lumen (arrows). The right P2 segment of the PCA ran parallel to the right superior cerebellar artery (arrow). (d) Black-blood imaging using a T1-weighted turbo-spin echo sequence revealed thickening of the arterial wall due to an atherosclerotic plaque (arrowheads).

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