Background: Prominent hypointense vessel sign (PHVS) is visualized on susceptibility weighted-imaging (SWI) in acute ischaemic stroke (AIS). We aim to test if PHVS is associated with stroke outcome. Methods: Forty patients with acute middle cerebral artery occlusion were recruited. The presence of PHVS, cortical vessel sign (CVS), brush sign (BS) and susceptibility-diffuse weighted imaging mismatch (S-D mismatch) and Alberta Stroke Program Early CT Score (ASPECTS) on SWI were compared between the good outcome group (90-day modified Rankin scale [mRS] of 0–2) and the poor outcome group (mRS of 3–6). The receiver operating characteristic curves (ROC) were used to evaluate the predictive ability to poor outcome of above imaging characteristics. Results: The presence of PHVS, CVS, BS and S-D mismatch was significantly higher in the poor outcome group (p < 0.001, p = 0.001, p = 0.013, p = 0.014, respectively). SWI-ASPECTS was significantly lower in the poor outcome group (p = 0.002). Regression analysis revealed SWI-ASPECTS; the presence of PHVS and CVS were independently associated with poor outcome (OR 0.347, p = 0.012; OR 55.77, p = 0.004; OR 58.05, p = 0.005). ROC analysis showed that PHVS had the highest predictive value for poor outcome (AUC 0.783). Conclusions: The presence of PHVS, CVS and SWI-ASPECTS were associated with poor outcome in AIS. The presence of PHVS was the most effective radiographic marker for predicting outcome.

Nezu T, Koga M, Nakagawara J, et al: Early ischemic change on CT versus diffusion-weighted imaging for patients with stroke receiving intravenous recombinant tissue-type plasminogen activator therapy: stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. Stroke 2011; 42: 2196–2200.
Ryan A, Tudor G, Maarten G, et al: Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction. Stroke 2015; 46: 407–412.
Soize S, Tisserand M, Charron S, Turc G, et al: How sustained Is 24-hour diffusion-weighted imaging lesion reversal? Serial magnetic resonance imaging in a patient cohort thrombolyzed within 4.5 hours of stroke onset. Stroke 2015; 46: 704–710.
Labeyrie MA, Turc G, Hess A, et al: Diffusion lesion reversal after thrombolysis: a MR correlate of early neurological improvement. Stroke 2012; 43: 2986–2991.
Haussen DC, Dehkharghani S, Rangaraju S, et al: Automated CT perfusion ischemic core volume and noncontrast CT ASPECTS (alberta stroke program early CT score): correlation and clinical outcome prediction in large vessel stroke. Stroke 2016; 47: 2318–2322.
Abduljalil AM, Schmalbrock P, Novak V, et al: Enhanced gray and white matter contrast of phase susceptibility-weighted images in ultra-high-field magnetic resonance imaging. J Magn Reson Imaging 2003; 18: 284–290.
Haacke EM, Mittal S, Wu Z, et al: Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. Am J Neuroradiol 2009; 30: 19–30.
Mittal P, Kalia V, Dua S: Pictorial essay: susceptibility-weighted imaging in cerebral ischemia. Indian J Radiol Imaging 2010; 20: 250–253.
Baik SK, Choi W, Oh SJ, et al: Change in cortical vessel signs on susceptibility-weighted images after full recanalization in hyperacute ischemic stroke. Cerebrovasc Dis 2012; 34: 206–212.
Hermier M, Nighoghossian N, Derex L, et al: Hypointense transcerebral veins at T2*-weighted MRI: a marker of hemorrhagic transformation risk in patients treated with intravenous tissue plasminogen activator. J Cereb Blood Flow Metab 2003; 23: 1362–1370.
Mucke J, Mohlenbruch M, Kickingereder P, et al: Asymmetry of deep medullary veins on susceptibility weighted MRI in patients with acute MCA stroke is associated with poor outcome. PLoS One 2015; 10:e0120801.
Lou M, Chen Z, Wan J, et al: Susceptibility-diffusion mismatch predicts thrombolytic outcomes: a retrospective cohort study. Am J Neuroradiol 2014; 35: 2061–2067.
Huang P, Chen CH, Lin WC, et al: Clinical applications of susceptibility weighted imaging in patients with major stroke. J Neurol 2012; 259: 1426–1432.
Payabvash S, Taleb S, Benson JC, et al: Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications. Acta Radiology 2017; 58: 876–882.
Kasner SE: Clinical interpretation and use of stroke scales. Lancet Neurol 2006; 5: 603–612.
Park MG, Yang TI, Oh SJ, et al: Multiple hypointense vessels on susceptibility-weighted imaging in acute ischemic stroke: surrogate marker of oxygen extraction fraction in penumbra? Cerebrovasc Dis 2014; 38: 254–261.
Terasawa Y, Yamamoto N, Morigaki R, et al: Brush sign on 3-T T2-weighted MRI as a potential predictor of hemorrhagic transformation after tissue plasminogen activator therapy. Stroke 2014; 45: 274–276.
Chen CY, Chen CI, Tsai FY, et al: Prominent vessel sign on susceptibility weighted imaging in acute stroke: prediction of infarct growth and clinical outcome. PLoS One 2015; 10:e0131118.
Barber PA, Demchuk AM, Zhang J, et al: Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355: 1670–1674.
Barber PA, Hill MD, Eliasziw M, et al; -ASPECTS Study Group: Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 2005; 76: 1528–1533.
Sun W, Liu W, Zhang Z, et al: Asymmetrical cortical vessel sign on susceptibility-weighted imaging: a novel imaging marker for early neurological deterioration and unfavorable prognosis. Eur J Neurol 2014; 21: 1411–1418.
Yu X, Yuan L, Jackson A, et al: Prominence of medullary veins on susceptibility-weighted images provides prognostic information in patients with subacute stroke. Am J Neuroradiol 2016; 37: 423–429.
Fujioka M, Okuchi K, Iwamura A, et al: A mismatch between the abnormalities in diffusion- and susceptibility-weighted magnetic resonance imaging may represent an acute ischemic penumbra with misery perfusion. J Stroke Cerebrovasc Dis 2013; 22: 1428–1431.
Polan RM, Poretti A, HuismanTA, et al: Susceptibility-weighted imaging in pediatric arterial ischemic stroke: a valuable alternative for the noninvasive evaluation of altered cerebral hemodynamics. Am J Neuroradiol 2015; 36: 783–788.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.