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Clinical Neuroradiology

, Volume 29, Issue 4, pp 685–692 | Cite as

Susceptibility Vessel Sign and Cardioembolic Etiology in the THRACE Trial

  • Romain BourcierEmail author
  • Imad Derraz
  • Béatrice Delasalle
  • Marine Beaumont
  • Sebastien Soize
  • Laurence Legrand
  • Hubert Desal
  • Serge Bracard
  • Olivier Naggara
  • Catherine Oppenheim
  • THRACE investigators
Original Article

Abstract

Purpose

The susceptibility vessel sign (SVS) has been described on gradient echo (GRE) magnetic resonance imaging (MRI) in acute ischemic stroke patients by large vessel occlusion. The presence of SVS (SVS+) was associated with treatment outcome and stroke etiology with conflicting results. Based on multicenter data from the THRombectomie des Artères CErebrales (THRACE) study, we aimed to determine if the association between SVS and cardioembolic etiology (CE) was independent of GRE sequence parameters.

Material and Methods

Patients with a pretreatment brain GRE sequence were identified. Logistic regression tested the association between SVS+, CE, time from onset to imaging and GRE sequence parameters (e.g. echo time, voxel size, field strength). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the SVS to predict a stroke from a CE.

Results

An SVS+ was observed in 237 out of 287 (83%) patients. In the univariate analysis, there was a significant association between SVS+ and a CE with an odds ratio (OR) and 95% confidence interval (95% CI) of 2.10 (1.02–4.29), respectively (p = 0.04) but not with GRE sequence parameters. In multivariate analysis, there was an independent relationship between SVS+ and CE (OR [95% CI]: 2.14 [1.02–4.45], p = 0.04). Sensitivity and specificity of SVS+ to predict CE were 0.89 and 0.21, respectively. The PPV and NPV of SVS+ were 0.44 and 0.78, respectively.

Conclusion

The presence of SVS is associated to CE, independent of GRE sequence parameters. While the specificity and the PPV of the sign were low, CE seems less likely in the absence of an SVS.

Keywords

Thrombus Magnetic resonance imaging Ischemia 

Notes

The THRACE trial investigators

are Alain Bonafé (Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France), Xavier Leclerc (Department of Radiology, University Hospital of Lille, Lille, France), Nelly Agrinier (Department of Clinical Epidemiology INSERM CIC-EC 1433, University of Lorraine and University Hospital of Nancy, Nancy, France), Serge Bakchine (Department of Neurology, University Hospital of Reims, Reims, France), Flore Baronnet (Stroke Unit, Pitié-Salpêtrière Hospital Group and Paris 6 University—Pierre et Marie Curie, Paris, France), Marine Beaumont (Department of INSERM CIC-IT, University of Lorraine and University Hospital of Nancy, Nancy, France), Yannick Bejot (Department of Neurology, University Hospital of Dijon, Dijon, France), Jerome Berge (Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France), Marc Bintner (Department of Neuroradiology Sud-Reunion Hospital Group, Saint Pierre, France), Romain Bourcier (Department of Interventional and Diagnostic Neuroradiology, University Hospital of Nantes, Nantes, France), Tae Hee Cho (Department of Neurology, University Hospital of Lyon, Lyon, France), Frédéric Clarencon (Department of Interventional Neuroradiology Pitié-Salpêtrière Hospital Group and Paris 6 University—Pierre et Marie Curie, Paris, France), Julien Cogez (Department of Neurology, University Hospital of Caen, Caen, France), Charlotte Cordonnier (Department of Neurology, University Hospital of Lille, Lille, France), Christian Denier (Department of Neurology, University Hospital of Bicêtre, Le Kremlin-Bicêtre, France), Anne Laure Derelle (Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France), Olivier Detante (Department of Neurology, University Hospital of Grenoble, Grenoble, France), Anthony Faivre (Department of Neurology, Hôpital d’Instruction des Armées, Sainte Anne, Toulon, France), Anne Ferrier, (Department of Neurology, University Hospital Gabriel-Montpied, Clermont-Ferrand, France), Laetitia Gimenez (Department of Neurology, University Hospital of Limoges, Limoges, France), Sophie Godard (Department of Neurology, University Hospital of Angers, Angers, France), Benoit Guillon (Department of Neurology, University Hospital of Nantes, Nantes, France), Emmanuel Houdart (Department of Neuroradiology, University Hospital Lariboisière, Paris, France), Bertrand Lapergue (Department of Neurology, Foch Hospital, Suresnes, France), Mariano Musacchio (Department of Neuroradiology, Pasteur Hospital, Colmar, France), Olivier Naggara (Department of Neuroradiology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France), Jean Philippe Neau (Department of Neurology, University Hospital of Poitiers, Poitiers, France), Michael Obadia (Department of Neurology, Rothschild Ophthalmological Foundation, Paris, France), Anne Pasco-Papon (Department of Radiology, University Hospital of Angers, Angers, France), Michel Piotin (Department of Interventional Neuroradiology [MP] Rothschild Ophthalmological Foundation, Paris, France), Laurent Pierot (Department of Neuroradiology, University Hospital of Reims, Reims, France), Helene Raoult (Department of Neuroradiology, University Hospital of Rennes, Rennes, France), Sébastien Richard (Department of Neurology University Hospital of Nancy, Nancy, France), Frederic Ricolfi (Department of Neuroradiology, University Hospital of Dijon, Dijon, France), Thomas Ronziere (Department of Neurology, University Hospital of Rennes, Rennes, France), Guillaume Saliou (Department of Neuroradiology, University Hospital of Bicêtre, Le Kremlin-Bicêtre, France), Igor Sibon (Department of Neurology, University Hospital of Bordeaux, Bordeaux, France), Sebastien Soize (Department of Neuroradiology, University Hospital of Reims, Reims, France), Jacques Sedat (Department of Radiology, University Hospital of Nice, Nice, France), Christian Stapf (Department of Neurology, University Hospital Lariboisière, Paris, France), Laurent Suissa (Department of Neurology, University Hospital of Nice, Nice, France), Marie Tisserand (Department of Neuroradiology, Sainte-Anne Hospital and Paris—Descartes University, INSERM U894, Paris, France), Francis Turjman (Department of Interventional Neuroradiology, University Hospital of Lyon, Lyon, France), and Stephane Velasco (Departments of Radiology, University Hospital of Poitiers, Poitiers, France).

Funding

The French Ministry for Health funded this study as part of its 2009 STIC program for the support of costly innovations (grant number 2009 A00753-54).

Compliance with ethical guidelines

Conflict of interest

R. Bourcier, I. Derraz, B. Delasalle, M. Beaumont, S. Soize, L. Legrand, H. Desal, S. Bracard, O. Naggara and C. Oppenheim declare that they have no competing interests.

Ethical standards

Written informed consent was obtained from all patients or their legal representatives. The study protocol was approved by the Comité de Protection des Personnes III Nord Est Ethics Committee and the research boards of the participating centers.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Romain Bourcier
    • 1
    Email author
  • Imad Derraz
    • 2
  • Béatrice Delasalle
    • 3
    • 9
  • Marine Beaumont
    • 4
    • 10
    • 11
  • Sebastien Soize
    • 5
    • 8
  • Laurence Legrand
    • 6
    • 12
  • Hubert Desal
    • 1
  • Serge Bracard
    • 2
  • Olivier Naggara
    • 6
    • 7
    • 12
  • Catherine Oppenheim
    • 6
    • 12
  • THRACE investigators
  1. 1.Department of Diagnostic and Interventional NeuroradiologyGuillaume et René Laennec University HospitalNantesFrance
  2. 2.Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital of MontpellierMontpellierFrance
  3. 3.L’institut du thoraxCentre Hospitalier Universitaire NantesNantesFrance
  4. 4.CIC1433, INSERMUniversité de LorraineNancyFrance
  5. 5.Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital of ReimsReimsFrance
  6. 6.Department of NeuroradiologyUniversité Paris-DescartesParisFrance
  7. 7.Pediatric Radiology DepartmentNecker Enfants MaladesParisFrance
  8. 8.INSERM UMR-S 1237 Physiopathology and imaging of neurological disordersUniversité Caen NormandieCaenFrance
  9. 9.UMR1087Institut National de la Santé et de la Recherche MédicaleNantesFrance
  10. 10.IADI, U1254Université de LorraineNancyFrance
  11. 11.CHRU de Nancy CIC-ITINSERMNancyFrance
  12. 12.INSERM U894Sainte-Anne HospitalParisFrance

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