Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France.
Clin Neuroradiol. 2019 Dec;29(4):685-692. doi: 10.1007/s00062-018-0699-8. Epub 2018 Jun 12.
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.
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.
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.
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.
大血管闭塞性急性缺血性脑卒中患者的梯度回波（GRE）磁共振成像（MRI）上已经描述了易损血管征（SVS）。SVS 的存在（SVS+）与治疗效果和卒中病因有关，但结果存在矛盾。基于 THRombectomie des Artères CErebrales（THRACE）研究的多中心数据，我们旨在确定 SVS 与心源性栓塞（CE）病因之间的关联是否独立于 GRE 序列参数。
确定了接受治疗前脑 GRE 序列的患者。逻辑回归测试了 SVS+、CE、从发病到成像的时间和 GRE 序列参数（例如回波时间、体素大小、场强）之间的关联。我们计算了 SVS 预测 CE 卒中的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）。
287 例患者中有 237 例（83%）观察到 SVS+。在单变量分析中，SVS+与 CE 之间存在显著关联，优势比（OR）和 95%置信区间（95%CI）分别为 2.10（1.02-4.29）（p=0.04），但与 GRE 序列参数无关。在多变量分析中，SVS+与 CE 之间存在独立关系（OR[95%CI]：2.14[1.02-4.45]，p=0.04）。SVS+预测 CE 的敏感性和特异性分别为 0.89 和 0.21。SVS+的阳性预测值和阴性预测值分别为 0.44 和 0.78。
SVS 的存在与 CE 相关，独立于 GRE 序列参数。虽然该征象的特异性和阳性预测值较低，但如果不存在 SVS，则 CE 不太可能发生。
