Lee Joonwon, Lee Ho-Joon, Ha Sam Yeol, Kim Hyung Chan, Kang Yeonah, Jin Sung-Chul, Park Seongho
Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
J Neuroimaging. 2023 Jan;33(1):147-155. doi: 10.1111/jon.13047. Epub 2022 Sep 6.
Recognizing the location and length of the thrombus responsible for large vessel occlusion in patients with acute ischemic stroke can facilitate effective endovascular recanalization therapy (ERT). We hypothesized that the aliasing or dipole effect produced by filtered-phase susceptibility-weighted imaging (SWI) would facilitate thrombus delineation.
Of the patients with middle cerebral artery occlusion who underwent ERT, we screened those who underwent noncontrast CT (NCCT), multiphase CT angiography (mCTA), and SWI before the endovascular procedure. We used an arbitrary index termed measurement of equivalence in thrombus assessed by digital subtraction angiography (METAD) defined as having the same location as the thrombus observed in the digital subtraction angiography (DSA) and length differing by less than 5 mm. For NCCT, mCTA, SWI_m (magnitude), and SWI_p (phase), the length of the thrombus and METAD were assessed.
The mean lengths of the thrombi determined using NCCT, mCTA, SWI_m, SWI_p, and DSA were 14.03, 13.47, 13.89, 9.93, and 8.96 mm, respectively. The absolute agreement for thrombus length was excellent for SWI_p and DSA (intraclass correlation coefficient [ICC] = .96), moderate for SWI_m and DSA (ICC = .53), and poor for mCTA and DSA (ICC = .14). The METADs were 26.7%, 40.0%, 33.3%, and 73.3% for NCCT, mCTA, SWI_m, and SWI_p, respectively. The METADs for NCCT and SWI_p were significantly different (p = .045) and those for mCTA and SWI_m were not (p = .537 and .093, respectively).
The SWI_p was best matched with the DSA for the measurement of the lengths and locations of thrombi. The use of pre-thrombectomy SWI_p imaging for acute ischemic stroke may facilitate a successful ERT strategy.
识别急性缺血性卒中患者中导致大血管闭塞的血栓位置和长度，有助于实施有效的血管内再通治疗（ERT）。我们推测，滤波后的相位对比增强磁共振血管造影（SWI）产生的混叠或偶极效应将有助于血栓的勾勒。
在接受ERT的大脑中动脉闭塞患者中，我们筛选出那些在血管内手术前接受了非增强CT（NCCT）、多期CT血管造影（mCTA）和SWI的患者。我们使用一个名为数字减影血管造影评估的血栓等效性测量（METAD）的任意指标，定义为与数字减影血管造影（DSA）中观察到的血栓位置相同，长度相差小于5毫米。对于NCCT、mCTA、SWI_m（幅度）和SWI_p（相位），评估血栓长度和METAD。
使用NCCT、mCTA、SWI_m、SWI_p和DSA确定的血栓平均长度分别为14.03、13.47、13.89、9.93和8.96毫米。SWI_p与DSA在血栓长度上的绝对一致性极佳（组内相关系数[ICC]=.96），SWI_m与DSA为中等（ICC=.53），mCTA与DSA较差（ICC=.14）。NCCT、mCTA、SWI_m和SWI_p的METAD分别为26.7%、40.0%、33.3%和73.3%。NCCT和SWI_p的METAD有显著差异（p=.045），mCTA和SWI_m的METAD无显著差异（分别为p=.537和.093）。
SWI_p在血栓长度和位置测量方面与DSA匹配最佳。在急性缺血性卒中的血栓切除术前使用SWI_p成像可能有助于成功的ERT策略。
