title: Change in cortical vessel signs on susceptibility-weighted images after full recanalization in hyperacute ischemic stroke.
abstract: BACKGROUND
  The cortical vessel signs (CVSs) on susceptibility-weighted images (SWIs) have been reported in patients with hyperacute ischemic stroke. We evaluated the change of this susceptibility sign on the immediate SWI after full recanalization and its clinical implications.
  
  
  METHODS
  Nineteen hyperacute ischemic stroke patients who had acute large artery occlusion and underwent post-recanalization SWI were enrolled in this study. The patients had ICA (internal carotid artery, 2 cases), M1 (M1 segment of middle cerebral artery, 7 cases), M2 (M2 segment of middle cerebral artery, 1 cases), T (intracranial ICA bifurcation, 2 cases), ICA/M1 (4 cases) and basilar artery (3 cases) occlusion on imaging studies before thrombolysis and they underwent immediate magnetic resonance imaging, including the SWI, after full recanalization. The recanalization status was evaluated using the thrombolysis in cerebral infarction (TICI) score before and after thrombolysis. The SWI images were evaluated for the presence of asymmetry of veins over the ischemic territory and this was correlated with the site of stenosis or occlusion. The veins in the ischemic territory were classified as 'prominent' if there were more numerous veins and/or large veins with a greater signal loss observed compared with the opposite normal hemisphere, 'equal' if there were no significant difference in appearance in both the cerebral hemispheres, and 'less' if the veins were decreased in the affected area as compared with that of the normal cortex. Baseline clinical parameters and clinical outcomes were reviewed.
  
  
  RESULTS
  The initial TICI grades were 0 in all cases. After thrombolysis, TICI grades were 3 in all cases. The pre-recanalization SWIs were obtained in 10 of 19 patients and all 10 showed prominent CVSs over the affected side, which disappeared on the post-recanalization SWI. On the post-recanalization SWI, the observed veins in the affected area were equal (10/19), less (5/19), and both equal and less (4/19). Patients with equal cortical veins in the affected area had small lesions on diffusion-weighted image (DWI) (10/19), while patients with less cortical veins had medium to large lesions on DWI (9/19).
  
  
  CONCLUSIONS
  The prominent CVSs on SWI can be indicative of acute thromboembolic occlusion and its change immediately after recanalization can be used to reflect the metabolic status. After recanalization, the appearance of the equal CVS (return to normal) on SWI was associated with a favorable clinical outcome and infarction was avoided in our small series study.
authors.affiliation: Department of Diagnostic Radiology, Research Institute for Convergence of Biomedical Science and Technology, Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. skbaik9@gmail.com
authors.forename: Seung Kug
authors.initials: SK
authors.lastname: Baik
authors.forename: Wonjin
authors.initials: W
authors.lastname: Choi
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Oh
authors.forename: Kyung-Pil
authors.initials: KP
authors.lastname: Park
authors.forename: Min-Gyu
authors.initials: MG
authors.lastname: Park
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Yang
authors.forename: Hae Woong
authors.initials: HW
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging; D004198:Disease Susceptibility / Q000453:epidemiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D014656:Vascular Surgical Procedures