Neurointervention.  2018 Sep;13(2):90-99. 10.5469/neuroint.2018.01039.

Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date

• Ko HC
• Ryu CW
• Yun SJ
• Koh JS
• Shin HS
• Kim EJ

• KMID: 2424057
• DOI: http://doi.org/10.5469/neuroint.2018.01039

Abstract

PURPOSE
Characteristic signs - the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) - on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy.
MATERIALS AND METHODS
We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed.
RESULTS
Nine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335-1.131 and OR, 0.993; 95% CI, 0.629-1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study.
CONCLUSION
Our meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.

Keyword

Susceptibility vessel sign; Prominent hypointense vessel sign; T2*-based MRI; Acute ischemic stroke; Reperfusion

MeSH Terms

Arteries
Humans
Magnetic Resonance Imaging
Odds Ratio
Reperfusion*
Stroke*
Thrombectomy

Figure

• 

  Fig. 1. (A) Representative image of “susceptibility vessel sign” on T2*-weighted gradient recalled echo scan. In a patient with left MCA occlusion, there is a hypointense blooming artifact (black arrow) beyond parent vessel lumen. (B) Representative image of “prominent hypointense vessel sign” on minimum intensity projection of susceptibility-weighted scan. The image of patient with right MCA occlusion shows multiple hypointense linear and branched vessels (white arrows) in the MCA territory. MCA, middle cerebral artery.

• 

  Fig. 2. (A) Forest plot showing odds ratio for recanalization after mechanical thrombectomy for acute stroke in comparison of a positive SVS and a negative SVS. The size of the black box corresponding to each study is proportional to the sample size. The horizontal line shows the corresponding 95% CI of the effect size (odds ratio). The combined estimate is based on a randomized-effects model shown by the diamond. The pooled estimate of odds ratios did not favor either of two arms. (B) Forest plot showing odds ratio for recanalization after intravenous thrombolysis for acute stroke in comparison of a positive SVS and a negative SVS. The pooled estimate of odds ratios did not favor either of two arms. SVS, susceptibility vessel sign; CI, confidence interval.

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