Abstract
Background
Magnetic resonance imaging (MRI) is the diagnostic cornerstone for precisely identifying acute ischaemic strokes and locating vascular occlusions, especially since mechanical thrombectomy has become a reference treatment. We observed that a post-contrast three-dimensional turbo-spin-echo T1-weighted sequence showed striking post-contrast vascular hyperintensities (PCVH) in ischaemic territories. We aimed to evaluate the prevalence and the meaning of this finding.
Methods
This retrospective single centre study included 130 consecutive patients admitted for acute ischaemic stroke with a 3-T MRI performed in the first 12 h of symptom onset from September 2014 through September 2016. Two neuroradiologists blinded to clinical data analysed the first MRI assessments. The association between PCVH and clinical, radiological and follow-up findings was assessed, as well as inter- and intra-observer agreements.
Results
Of 130 patients, 105 (81%) had PCVH in the ischaemic territory. PCVH were associated with the presence of thrombus on susceptibility weighted imaging (p < 0.0001) and vascular occlusions on MR angiography (p < 0.0001). All patients with a visible thrombus had PCVH closely surrounding the clot. PCVH were associated with higher initial (p < 0.01) and follow-up (p < 0.01) National Institutes of Health Stroke Scale score, and higher mRS score (p < 0.05). Thrombectomy was the reference treatment for all patients with arterial occlusions. Inter- and intra-observer agreements for the detection of PCVH were excellent (κ = 0.95 and κ = 0.91, respectively).
Conclusions
PCVH during acute strokes are a striking sensitive and reproducible tool for diagnosing and locating vascular occlusions. It may help triage patients who can benefit from thrombectomy.
Key points
• Post-contrast vascular hyperintensities (PCVH) are a sensitive MR finding in acute stroke
• PCVH are strongly associated with the presence and location of arterial occlusions
• Inter- and intra-observer agreements for the detection of PCVH are excellent
• PCVH are visible even in the case of significant motion artefacts
• PCVH may help triage patients who can benefit from mechanical thrombectomy
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Abbreviations
- FVH:
-
FLAIR Vascular Hyperintensities
- MSDE:
-
Motion Sensitised Driven Equilibrium
- MT:
-
Mechanical Thrombectomy
- NIHSS:
-
National Institutes of Health Stroke Scale
- PCVH:
-
Post-contrast Vascular Hyperintensities
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Acknowledgments
Laura McMaster provided professional English-language medical editing of this article. Malek Ben Maacha provided valuable data about mechanical thrombectomy devices.
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The authors state that this work has not received any funding.
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The scientific guarantor of this publication is Julien Savatovsky.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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Marie Astrid Metten kindly provided statistical advice for this manuscript.
One of the authors has significant statistical expertise.
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Methodology
• retrospective
• observational
• performed at one institution
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Duron, L., Savatovsky, J., Obadia, M. et al. Magnetic resonance post-contrast vascular hyperintensities at 3 T: a new highly sensitive sign of vascular occlusion in acute ischaemic stroke. Eur Radiol 28, 2903–2913 (2018). https://doi.org/10.1007/s00330-018-5312-7
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DOI: https://doi.org/10.1007/s00330-018-5312-7