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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1133-1138. doi: 10.19723/j.issn.1671-167X.2021.06.021

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Susceptibility vessel sign in subacute stroke patients with large vessel occlusion

REN Guo-yong1,2,WU Xue-mei2, 1,LI Jie-yu1,SUN Wei-ping1,△(),HUANG Yi-ning1   

  1. 1. Department of Neurology, Peking University First Hospital, Beijing 100034, China
    2. Department of Neurology, General Hospital of Taiyuan Iron & Steel CO., LTD.(TISCO), Taiyuan 030003, China]
  • Received:2020-01-15 Online:2021-12-18 Published:2021-12-13
  • Contact: Wei-ping SUN E-mail:swp_222@163.com
  • Supported by:
    National Natural Science Foundation of China(81400944);Peking University Interdisciplinary Seed Funding(BMU2018MX020)

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Abstract:

Objective: To investigate the presentation of susceptibility vessel sign (SVS) in subacute stroke patients with large vessel occlusion. Methods: We collected consecutive stroke patients who were admitted to Peking University First Hospital from December 2017 to August 2019 retrospectively. Those who had intracranial large vessel occlusion and received sensitivity weighted imaging (SWI) within 3 to 14 days after stroke onset were included in our analysis. The diagnosis of large vessel occlusion was based on magnetic resonance angiography (MRA), CT angiography (CTA) or digital subtraction angiography (DSA). The demographic information, clinical characteristics and imaging results were obtained from medical record. The occurrence rates of SVS sign were compared between stroke patients with cardioembolism (CE) and large artery atherosclerosis (LAA). In the sensitivity analysis, we performed a subgroup analysis in those patients who received SWI within 7 to 14 days after stroke onset. We also compared the occurrence rate of SVS sign between the patients with and without atrial fibrillation. Results: A total of 51 patients, 19 females and 32 males, with an average age of (63.04±11.23) years were analyzed in this study. Compared with LAA group, the patients in CE group were older and more likely to have an atrial fibrillation (P<0.05). There were no significant differences between the CE group and LAA group in gender, hypertension, diabetes, coronary heart disease, hyperlipidemia, smoking, or National Institute of Health stroke scale(NIHSS) score at admission. SVS sign was found in 30 patients. Of whom, 3 were in CE group and 27 in LAA group. The occurrence rate of SVS sign was higher in the LAA group than in the CE group significantly (65.9% vs. 30.0%, P=0.039). The subgroup analysis showed that, in the patients who received SWI examination within 7 to 14 days after stroke onset, the differences between the two groups were still statistically significant (0 vs. 72.7%, P=0.006). Another sensitivity analysis showed that, the rate of SVS in the patients with atrial fibrillation was significantly lower than those patients without atrial fibrillation (25% vs. 65.1%, P=0.043). Conclusion: In subacute stroke patients, the occurrence rate of SVS sign in CE group was lower than that of LAA group. The significance of SVS sign in the differentiation of stroke subtype needs further validation.

Key words: Susceptibility-weighted imaging, Large vessel occlusion, Stroke, Etiological type, Subacute stage

CLC Number: 

  • R741

Table 1

Baseline characteristics of cardioembolism group and large artery atherosclerosis stroke group"

Variable CE(n=10) LAA(n=41) t/χ2 P
Male, n(%) 5 (50.0) 27 (65.9) 0.319 0.572
Age/years, $\overline{x}$±s 70.60±13.53 61.20±9.94 2.495 0.016
Hypertension, n(%) 7 (70.0) 30 (73.2) 0.040 0.841
Diabetes mellitus, n(%) 6 (60.0) 21 (51.2) 0.021 0.884
Smoker, n(%) 4 (40.0) 23 (56.1) 0.315 0.573
Coronary heart disease, n(%) 2 (20.0) 7 (17.1) 0.046 0.830
Atrial fibrillation, n(%) 8 (80.0) 0 (0.00) - 0.000
Hyperlipidaemia, n(%) 5 (50.0) 26 (63.4) 0.175 0.676
NIHSS at admission, M(P25,P75) 2 (2, 6) 4 (2, 6) - 0.194

Figure 1

Susceptibility vessel sign of different occluded artery Digital substraction angiography (DSA) showed an occlusion of P1 segment of the right posterior cerebral artery (A) in a 39-year-old female patient and sensitivity weighted imaging (SWI) showed a positive susceptibility vessel sign (SVS) at the corresponding site (B). In a 54-year-old male patient, DSA confirmed the occlusion of M1 segment of the right middle cerebral artery (C) and SWI showed a significant SVS at the corresponding site (D). In a 49-year-old male patient, magnetic resonance angiography (MRA) found an occlusion at the distal of the right anterior cerebral artery (E) and SWI detected a corresponding SVS (F). Arrow points to the occlusion site of large vessel. Triangle points to the site of SVS."

Figure 2

Susceptibility vessel sign detected at different time points A, magnetic resonance angiography (MRA) showed an occluded left middle cerebral artery (MCA); B, a positive susceptibility vessel sign (SVS) was detected at the corresponding site at 5 days after stroke onset. MRA found an occlusion at the right MCA (C) and sensitivity weighted imaging (SWI) performed at 9 days after stroke onset showed a positive SVS at the corresponding site (D). The occluded right MCA confirmed by digital substraction angiography (E) showed a positive SVS on SWI at 14 days after stroke onset (F). Arrow points to the occlusion site of large vessel. Triangle points to the site of SVS."

Table 2

Imaging examination of cardioembolism group and large artery atherosclerosis stroke group"

Variable CE(n=10) LAA(n=41) t/χ2 P
Occluded artery MCA, n(%) 8 (80.0) 35 (85.4)
Others(ACA or PCA), n(%) 2 (20.0) 6 (14.6) 0.166 0.683
Interval from stroke onset to SWI/d, M(P25,P75) 6.50 (4.75, 9.00) 7.00 (5.00, 9.50) 0.774
SVS sign, n(%) 3 (30.0) 27 (65.9) 4.267 0.039
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