title: Two-layered susceptibility vessel sign on 3-tesla T2*-weighted imaging is a predictive biomarker of stroke subtype.
abstract: OBJECTIVE
  A susceptibility vessel sign (SVS) on 1.5-tesla (T)-T2*-weighted images may predict cardioembolism. It has also been detected in patients with large artery atherosclerosis. In patients with major vessel occlusion, the SVS was comprised 2 layers on 3T-T2*-weighted images. We assessed the efficacy of 2-layered SVS on 3T-T2*-weighted imaging scans for predicting cardioembolism.
  
  
  METHODS
  Our study included 132 patients who had ischemic stroke within the preceding 24 hours and presented with internal carotid artery or middle cerebral artery occlusion because of cardioembolism or large artery atherosclerosis. We compared 2-layered SVS and SVS on 3T-T2*-weighted imaging scans for their sensitivity, specificity, and diagnostic odds ratio for predicting cardioembolism.
  
  
  RESULTS
  We enrolled 132 patients (72 men; mean age, 74.5 years); of these, 63 (47.7%) were presented with cardioembolism. Although the sensitivity of SVS and 2-layered SVS for cardioembolism and large artery atherosclerosis was not statistically different (74.6% and 58.0%, respectively), the sensitivity of 2-layered SVS was significantly higher in patients with cardioembolism (42.9%) than those with large artery atherosclerosis (2.9%; P<0.001). The specificity and diagnostic odds ratio for 2-layered SVS for cardioembolism were 97.1% and 25.1; for SVS they were 42.0% and 2.1, respectively.
  
  
  CONCLUSIONS
  The specificity of 2-layered SVS for cardioembolism was high. It may be useful for predicting cardioembolism and for the management of patients with acute ischemic stroke.
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan. nobyamamoto521129@yahoo.co.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tada
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Harada
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yuishin
authors.initials: Y
authors.lastname: Izumi
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.affiliation: From the Department of Clinical Neurosciences (N.Y., Y.I., R.K.), Department of Neurosurgery (J.S., Y.T., S.N.), and Department of Radiology (M.H.), Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis*; D004617:Embolism / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000209:etiology
keywords: atherosclerosis; diagnostic imaging; internal carotid artery; intracranial embolism; magnetic resonance imaging; middle cerebral artery; occlusion