title: The susceptibility vessel sign at the proximal M1: a strong predictor for poor outcome after intravenous thrombolysis.
abstract: BACKGROUND
  Half of acute stroke patients have poor outcomes at 3 months even when treated with intravenous thrombolysis using tissue-plasminogen activator (t-PA) therapy. The aim of the present study was to evaluate the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) T2* at the proximal portion of the middle cerebral artery (M1 proximal SVS) on clinical outcome in anterior circulation stroke patients treated with t-PA.
  
  
  METHODS
  The presence of the M1 proximal SVS was assessed before t-PA therapy. Good outcome and poor outcome at 3 months were defined as a modified Rankin Scale score of 0 to 2 and 4 to 6, respectively. The predictive values of the M1 proximal SVS for a good and poor outcome were calculated.
  
  
  RESULTS
  161 patients (median age [interquartile], 76 [67-83] years; male, 91 [57%]) were enrolled. At 3 months after stroke, 68 (42%) patients achieved a good outcome, and 75 (47%) had a poor outcome. The M1 proximal SVS was found in 17 (11%) patients, of whom none (0%) achieved a good outcome, and 16 (94%) had a poor outcome. The sensitivity and positive predictive value of the M1 proximal SVS for good outcome were very low (0.000 and 0.000, respectively). Furthermore, the specificity and positive predictive value of the M1 proximal SVS for poor outcome were very high (0.988 and 0.941, respectively).
  
  
  CONCLUSIONS
  The M1 proximal SVS appears to be a strong predictor for poor outcome after t-PA therapy.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. Electronic address: aokijy@gmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Saji
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Nagai
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Clinical outcome; Ischemic stroke; MRI; Recanalization; Susceptibility vessel sign; Thrombolysis