Weisstanner Christian, Gratz Pascal P, Schroth Gerhard, Verma Rajeev K, Köchl Arnold, Jung Simon, Arnold Marcel, Gralla Jan, Zubler Christoph, Hsieh Kety, Mordasini Pasquale, El-Koussy Marwan
Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Eur Radiol. 2014 Aug;24(8):1735-41. doi: 10.1007/s00330-014-3200-3. Epub 2014 May 16.
Susceptibility-weighted imaging (SWI) enables visualization of thrombotic material in acute ischemic stroke. We aimed to validate the accuracy of thrombus depiction on SWI compared to time-of-flight MRA (TOF-MRA), first-pass gadolinium-enhanced MRA (GE-MRA) and digital subtraction angiography (DSA). Furthermore, we analysed the impact of thrombus length on reperfusion success with endovascular therapy.
Consecutive patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusions undergoing endovascular recanalization were screened. Only patients with a pretreatment SWI were included. Thrombus visibility and location on SWI were compared to those on TOF-MRA, GE-MRA and DSA. The association between thrombus length on SWI and reperfusion success was studied.
Eighty-four of the 88 patients included (95.5%) showed an MCA thrombus on SWI. Strong correlations between thrombus location on SWI and that on TOF-MRA (Pearson's correlation coefficient 0.918, P < 0.001), GE-MRA (0.887, P < 0.001) and DSA (0.841, P < 0.001) were observed. Successful reperfusion was not significantly related to thrombus length on SWI (P = 0.153; binary logistic regression).
In MCA occlusion thrombus location as seen on SWI correlates well with angiographic findings. In contrast to intravenous thrombolysis, thrombus length appears to have no impact on reperfusion success of endovascular therapy.
• SWI helps in assessing location and length of thrombi in the MCA • SWI, MRA and DSA are equivalent in detecting the MCA occlusion site • SWI is superior in identifying the distal end of the thrombus • Stent retrievers should be deployed over the distal thrombus end • Thrombus length did not affect success of endovascular reperfusion guided by SWI.
磁敏感加权成像（SWI）能够显示急性缺血性卒中的血栓物质。我们旨在验证与时间飞跃法磁共振血管造影（TOF-MRA）、首次通过钆增强磁共振血管造影（GE-MRA）及数字减影血管造影（DSA）相比，SWI上血栓显示的准确性。此外，我们分析了血栓长度对血管内治疗再灌注成功的影响。
对因大脑中动脉（MCA）闭塞而接受血管内再通治疗的急性缺血性卒中连续患者进行筛查。仅纳入有治疗前SWI检查的患者。将SWI上血栓的可见性及位置与TOF-MRA、GE-MRA和DSA上的进行比较。研究SWI上血栓长度与再灌注成功之间的关联。
纳入的88例患者中有84例（95.5%）在SWI上显示有MCA血栓。观察到SWI上血栓位置与TOF-MRA上的（Pearson相关系数0.918，P<0.001）、GE-MRA上的（0.887，P<0.001）及DSA上的（0.841，P<0.001）有很强的相关性。成功再灌注与SWI上的血栓长度无显著相关性（P=0.153；二元逻辑回归）。
在MCA闭塞中，SWI上所见血栓位置与血管造影结果相关性良好。与静脉溶栓不同，血栓长度似乎对血管内治疗再灌注成功无影响。
• SWI有助于评估MCA中血栓的位置和长度 • SWI与MRA及DSA在检测MCA闭塞部位方面相当 • SWI在识别血栓远端方面更具优势 • 应将支架取栓器置于血栓远端 • 血栓长度不影响SWI引导下血管内再灌注的成功。
