Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
PLoS One. 2013 May 23;8(5):e63459. doi: 10.1371/journal.pone.0063459. Print 2013.
Time-of-flight (TOF) angiography detects embolic occlusion of arteries in patients with acute ischemic stroke due to the absence of blood flow in the occluded vessel. In contrast, susceptibility weighted imaging (SWI) directly enables intravascular clot visualization due to hypointense susceptibility vessel signs (SVS) in the occluded vessel. The aim of this study was to compare the diagnostic accuracy of both methods to determine vessel occlusion in patients with acute stroke.
94 patients were included who presented with clinical symptoms for acute stroke and displayed a delay on the time-to-peak perfusion map in the territory of the anterior (ACA), middle (M1, M1/M2, M2/M3) or posterior (PCA) cerebral artery. The frequency of SVS on SWI and vessel occlusion or stenosis on TOF-angiography was compared using the McNemar-Test.
87 of 94 patients displayed a clearly definable SVS on SWI. In 72 patients the SVS was associated with occlusion or stenosis on TOF-angiography. Fifteen patients exclusively displayed SVS on SWI (14 M2/M3, 1 M1), whereas no patient revealed exclusively occlusion or stenosis on TOF-angiography. Sensitivity for detection of embolic occlusion within major vessel segments (M1, M1/M2, ACA, and PCA) did not show any significant difference between both techniques (97% for SWI versus 96% for TOF-angiography) while the sensitivity for detection of embolic occlusion within M2/M3 was significantly different (84% for SWI versus 39% for TOF-angiography, p<0.00012).
SWI and TOF-angiography provide similar sensitivity for central thrombi while SWI is superior for the detection of peripheral thrombi in small arterial vessel segments.
时间飞跃（TOF）血管造影术通过检测闭塞血管中血流缺失，检测急性缺血性脑卒中患者的动脉栓塞闭塞。相比之下，磁敏感加权成像（SWI）通过检测闭塞血管中的低信号磁敏感血管征（SVS），直接实现血管内血栓可视化。本研究旨在比较两种方法的诊断准确性，以确定急性脑卒中患者的血管闭塞情况。
纳入了 94 名因急性脑卒中出现临床症状并在其前循环（ACA）、中循环（M1、M1/M2、M2/M3）或后循环（PCA）脑动脉的达峰时间灌注图上显示延迟的患者。使用 McNemar 检验比较 SWI 上 SVS 的出现频率和 TOF 血管造影上的血管闭塞或狭窄情况。
94 名患者中有 87 名在 SWI 上显示出明确可定义的 SVS。在 72 名患者中，SVS 与 TOF 血管造影上的闭塞或狭窄相关。15 名患者仅在 SWI 上显示 SVS（14 名 M2/M3，1 名 M1），而没有患者仅在 TOF 血管造影上显示闭塞或狭窄。两种技术检测主要血管节段（M1、M1/M2、ACA 和 PCA）内栓塞性闭塞的敏感性没有明显差异（SWI 为 97%，TOF 血管造影为 96%），而 M2/M3 内栓塞性闭塞的敏感性差异有统计学意义（SWI 为 84%，TOF 血管造影为 39%，p<0.00012）。
SWI 和 TOF 血管造影术对中心血栓的敏感性相似，而 SWI 对小动脉血管节段的外周血栓检测更具优势。
