Magnetic resonance post-contrast vascular hyperintensities at 3 T: a new highly sensitive sign of vascular occlusion in acute ischaemic stroke
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.
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.
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).
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.
• 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
KeywordsStroke Cerebrovascular disorders Magnetic resonance imaging Neuroimaging Prognosis
FLAIR Vascular Hyperintensities
Motion Sensitised Driven Equilibrium
National Institutes of Health Stroke Scale
Post-contrast Vascular Hyperintensities
Laura McMaster provided professional English-language medical editing of this article. Malek Ben Maacha provided valuable data about mechanical thrombectomy devices.
Compliance with ethical standards
The scientific guarantor of this publication is Julien Savatovsky.
Conflict of interest
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.
Statistics and biometry
Marie Astrid Metten kindly provided statistical advice for this manuscript.
One of the authors has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• performed at one institution
- 4.Haute Autorité de Santé (2016) Thrombectomie des artères intracrâniennes par voie endovasculaire, France. https://www.has-sante.fr/portail/upload/docs/application/pdf/2016-11/rapport_thrombectomie.pdf. Accessed 12 Nov 2017
- 7.Schellinger PD, Bryan RN, Caplan LR et al (2010) Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 75:177–185CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Haute Autorité de Santé (2009) Accident vasculaire cérébral (AVC): prise en charge précoce, France. https://www.has-sante.fr/portail/upload/docs/application/pdf/2009-07/avc_prise_en_charge_precoce_-_recommandations.pdf. Accessed 12 Nov 2017
- 14.R Core Team (2015) R: a language and environment for statistical computing. http://www.r-project.org/. Accessed 4 Nov 2017
- 15.Yoo AJ, Verduzco LA, Schaefer PW et al (2009) MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 40:2046–2054CrossRefPubMedPubMedCentralGoogle Scholar