title: Asymmetry of deep medullary veins on susceptibility weighted MRI in patients with acute MCA stroke is associated with poor outcome.
abstract: OBJECTIVE
  Due to its sensitivity to deoxyhemoglobin, susceptibility weighted imaging (SWI) enables the visualization of deep medullary veins (DMV) in patients with acute stroke, which are difficult to depict under physiological circumstances. This study assesses the asymmetric appearance of prominent DMV as an independent predictor for stroke severity and outcome.
  
  
  METHODS
  SWI of 86 patients with acute middle cerebral artery (MCA) stroke were included. A scoring system from 0 (no visible DMV) to 3 (very prominent DMV) was applied for both hemispheres separately. A difference of scores between ipsi- and contralateral side was defined as asymmetric (AMV+). Occurrence of AMV+ was correlated with the National Institute of Health Stroke Scale (NIHSS) Score on admission and discharge, as well as the modified Rankin Scale (mRS) at discharge. Ordinal regression analysis was used to evaluate NIHSS and mRS as predictors of stroke severity, clinical course of disease and outcome.
  
  
  RESULTS
  55 patients displayed AMV+ while 31 did not show an asymmetry (AMV-). Median NIHSS on admission was 17 (11-21) in the AMV+ group and 9 (5-15) in the AMV- group (p = 0.001). On discharge median NIHSS was 11 (5-20) for AMV+ and 5 (2-14) for AMV- (p = 0.005). The median mRS at discharge was 4 (3-5) in the AMV+ group and 3 (1-4) in AMV- (p = 0.001). Odds ratio was 3.19 (95% CI: 1.24-8.21) for AMV+ to achieve a higher mRS than AMV- (p = 0.016).
  
  
  CONCLUSIONS
  The asymmetric appearance of DMV on SWI is a fast and easily evaluable parameter for the prediction of stroke severity and can be used as an additional imaging parameter in patients with acute MCA stroke.
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany.
authors: Johanna
authors: J
authors: Mucke
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany.
authors: Markus
authors: M
authors: Möhlenbruch
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany.
authors: Philipp
authors: P
authors: Kickingereder
authors: University of Mannheim, Department of Psychology, Schloss Ehrenhof Ost, 68131 Mannheim, Germany.
authors: Pascal J
authors: PJ
authors: Kieslich
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany.
authors: Philipp
authors: P
authors: Bäumer
authors: University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany.
authors: Christoph
authors: C
authors: Gumbinger
authors: University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany.
authors: Jan
authors: J
authors: Purrucker
authors: University of Heidelberg, Department of Neurology, INF 400, 69120 Heidelberg, Germany.
authors: Sibu
authors: S
authors: Mundiyanapurath
authors: German Cancer Research Center (DKFZ), Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors: Heinz-Peter
authors: HP
authors: Schlemmer
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany.
authors: Martin
authors: M
authors: Bendszus
authors: University of Heidelberg, Department of Neuroradiology, INF 400, 69120 Heidelberg, Germany; German Cancer Research Center (DKFZ), Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors: Alexander
authors: A
authors: Radbruch
mesh_terms: D000208:Acute Disease; D000368:Aged; D002550:Cerebral Veins / Q000002:abnormalities / Q000473:pathology*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000401:mortality*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate