Background: The susceptibility vessel sign on gradient echo-type-T2*-weighted imaging is a well-known marker of arterial occlusion. Stagnant flow in front of the middle cerebral artery (MCA) occlusion sites may contribute to the intra-arterial, high-intensity signal on arterial spin labeling magnetic resonance imaging (MRI), making it another potential marker of MCA occlusion. We compared the intra-arterial, high-intensity signal and susceptibility vessel sign in patients with symptomatic MCA occlusion and patients without major vessel occlusion. Methods: We identified transient ischemic attack or ischemic stroke patients with (1) 3-T MRI performed within 24 h after clinical onset including arterial spin labeling, T2*-weighted imaging, and magnetic resonance angiography (MRA) and (2) either having MCA occlusion (n = 34 patients) or without major vessel occlusion (n = 24 patients). The intra-arterial, high-intensity signal was defined as an enlarged circular or linear bright hyperintensity within the artery. The susceptibility vessel sign was defined as an enlarged spot of hypointensity within the MCA, in which the diameter of the hypointense signal within the vessel exceeded the contralateral vessel diameter. The presence or absence of the intra-arterial, high-intensity signal and susceptibility vessel sign were assessed, along with their inter-rater agreement and consistency with the presence of MCA occlusion on MRA. Results: The intra-arterial, high-intensity signal was detectable in 30 patients (52%), and susceptibility vessel sign was observed in 17 patients (29%). The sensitivity of the intra-arterial high-intensity signal was significantly higher than that of the susceptibility vessel sign (88% vs. 50%; p < 0.05). The accuracy of the intra-arterial high-intensity signal was also higher than that of the susceptibility vessel sign (93% vs. 71%; p < 0.05). The intra-arterial high-intensity signal was situated in the proximal regions of the susceptibility vessel sign on T2*WI within the MCA. Neither the intra-arterial high-intensity signal nor the susceptibility vessel sign was observed in patients without major vessel occlusion. Inter-rater agreement was good for intra-arterial high-intensity signal detection (κ = 0.73) and moderate for susceptibility vessel sign detection (κ = 0.47). The presence or absence of the intra-arterial high-intensity signal was highly consistent with that of MCA occlusion on MRA (κ = 0.74). Conclusions: The intra-arterial high-intensity signal on arterial spin labeling appears to be useful to identify the presence of acute MCA occlusion and may be associated with stagnant flow in front of occlusion sites. The intra-arterial high-intensity signal may also be used to identify the occlusion site.

Morita N, Harada M, Uno M, Matsubara S, Matsuda T, Nagahiro S, Nishitani H: Ischemic findings of T2*-weighted 3-tesla MRI in acute stroke patients. Cerebrovasc Dis 2008;26:367-375.
Bokkers RP, Hernandez DA, Merino JG, Mirasol RV, van Osch MJ, Hendrikse J, Warach S, Latour LL; National Institutes of Health Stroke Natural History I: Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke 2012;43:1290-1294.
Griebe M, Kern R, Eisele P, Sick C, Wolf ME, Sauter-Servaes J, Gregori J, Gunther M, Hennerici MG, Szabo K: Continuous magnetic resonance perfusion imaging acquisition during systemic thrombolysis in acute stroke. Cerebrovasc Dis 2013;35:554-559.
Detre JA, Samuels OB, Alsop DC, Gonzalez-At JB, Kasner SE, Raps EC: Noninvasive magnetic resonance imaging evaluation of cerebral blood flow with acetazolamide challenge in patients with cerebrovascular stenosis. J Magn Reson Imaging 1999;10:870-875.
Zaharchuk G, Do HM, Marks MP, Rosenberg J, Moseley ME, Steinberg GK: Arterial spin-labeling MRI can identify the presence and intensity of collateral perfusion in patients with moyamoya disease. Stroke 2011;42:2485-2491.
Wolf RL, Alsop DC, McGarvey ML, Maldjian JA, Wang J, Detre JA: Susceptibility contrast and arterial spin labeled perfusion MRI in cerebrovascular disease. J Neuroimaging 2003;13:17-27.
Sakamoto Y, Kimura K, Sakai K: M1 susceptibility vessel sign and hyperdense middle cerebral artery sign in hyperacute stroke patients. Eur Neurol 2012;68:93-97.
Cho KH, Kim JS, Kwon SU, Cho AH, Kang DW: Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke 2005;36:2379-2383.
Kimura K, Iguchi Y, Shibazaki K, Watanabe M, Iwanaga T, Aoki J: M1 susceptibility vessel sign on T2* as a strong predictor for no early recanalization after IV-t-PA in acute ischemic stroke. Stroke 2009;40:3130-3132.
Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL, Zheng DD, Abolian AM, Kim D, Ali LK, Shah SH, Towfighi A, Ovbiagele B, Kidwell CS, Tateshima S, Jahan R, Duckwiler GR, Vinuela F, Salamon N, Villablanca JP, Vinters HV, Marder VJ, Saver JL: CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke 2011;42:1237-1243.
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