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Comparison of 3D multi-echo gradient-echo and 2D T2* MR sequences for the detection of arterial thrombus in patients with acute stroke

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Abstract

Objectives

We compared a multi-echo gradient-echo magnetic resonance sequence (susceptibility-weighted angiography [SWAN]) with the T2* sequence for the detection of an arterial thrombus in acute ischaemic stroke.

Methods

Seventy-four consecutive patients with acute ischaemic stroke were included. Proximal arterial occlusions were diagnosed using time-of-flight (TOF) magnetic resonance angiography (MRA). Two-dimensional (2D) axial reformats from 3D SWAN were generated to match with 2D T2* images. For arterial thrombus detection, each set of MR images (T2*, 2D SWAN reformats and 3D multiplanar SWAN images) was examined independently and separately by three observers who assigned the images to one of three categories: (0) absence of thrombus, (1) uncertain thrombus, (2) certain thrombus. Agreement and diagnostic accuracy were calculated.

Results

Twenty-four proximal arterial occlusions involving the anterior (n = 20) or posterior (n = 4) circulation were found. Inter-observer agreement was moderate using T2* images (κ = 0.58), good using 2D SWAN reformats (κ = 0.83) and excellent using multiplanar SWAN images (κ = 0.90). For the diagnosis of thrombus, T2* images were 54 % sensitive and 86 % specific, 2D SWAN reformats were 83 % sensitive and 94 % specific and SWAN multiplanar analysis was 96 % sensitive and 100 % specific.

Conclusions

Three-dimensional SWAN sequence improves the detection of arterial thrombus in patients with acute ischaemic stroke in comparison with the 2D T2* sequence.

Key Points

• Multi-echo gradient-echo MR (e.g. susceptibility-weighted angiograph, [SWAN]) is increasingly used in neuroradiology.

• Compared with conventional T2* sequences, SWAN improves detection of arterial thrombus.

• Multiplanar SWAN analysis had the best diagnostic performance for arterial thrombus detection.

• Sensitivity was 96 % and specificity 100 %.

• Findings support combination of time-of-flight and susceptibility effects in suspected acute stroke.

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Abbreviations

SWI:

Susceptibility-weighted imaging

TOF MRA:

Time-of-flight magnetic resonance angiography

SWAN:

Susceptibility-weighted angiography

GRE:

Gradient echo

ACA:

Anterior cerebral artery

PCA:

Posterior cerebral artery

MCA:

Middle cerebral artery

FLAIR:

Fluid-attenuated inversion recovery

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Acknowledgements

Cecile Rabrait is an employee of General Electric

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Authors and Affiliations

  1. Department of Radiology, Hôpital Saint Joseph, 186, rue Raymond Losserand, Paris, France

    Jérôme Hodel, Wassef Khaled, Mathieu Rodallec, Sophie Gerber & Marc Zins

  2. Department of Neuroradiology, CHRU Roger Salengro, Lille, France

    Jérôme Hodel & Xavier Leclerc

  3. Department of Neuroradiology, Fondation Ophtalmologique Rothschild, Paris, France

    Raphael Blanc & Oriane Lambert

  4. Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Radiation Epidemiology Team, Villejuif, France

    Mohamed Benadjaoud

  5. GE Healthcare, Clinical Science Development Group, Buc, France

    Cécile Rabrait

  6. Department of Neurology, Hôpital Saint Joseph, Paris, France

    Ruben Tamazyan & Mathieu Zuber

  7. Department of Radiology, Hôpital Henri Mondor, Créteil, France

    Alain Rahmouni

Authors
  1. Jérôme Hodel
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  2. Xavier Leclerc
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  3. Wassef Khaled
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  9. Oriane Lambert
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  10. Cécile Rabrait
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  13. Marc Zins
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Corresponding author

Correspondence to Jérôme Hodel.

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Hodel, J., Leclerc, X., Khaled, W. et al. Comparison of 3D multi-echo gradient-echo and 2D T2* MR sequences for the detection of arterial thrombus in patients with acute stroke. Eur Radiol 24, 762–769 (2014). https://doi.org/10.1007/s00330-013-3061-1

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  • DOI: https://doi.org/10.1007/s00330-013-3061-1

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