title: The susceptibility vessel sign containing two compositions on 3-tesla T2*-weighted image and single corticosubcortical infarct on diffusion-weighted image are associated with cardioembolic stroke.
abstract: BACKGROUND
  Although accurate diagnosis of the ischemic stroke subtype is one of the most important factors for selection of therapeutic approach, it is sometimes difficult at the time of admission. We previously reported that susceptibility vessel sign (SVS) with two layers (termed two-layered SVS) on 3-tesla-T2*-weighted image (T2*-WI) might be useful to predict cardioembolic stroke in patients with cerebral major vessel occlusion. We studied about biomarkers on magnetic resonance imaging (MRI), including two-layered SVS for diagnosing cardioembolic stroke.
  
  
  METHODS
  We included 132 ischemic stroke patients within 24h from onset who suffered internal carotid artery or middle cerebral artery occlusion due to cardioembolic stroke (group CE) or large artery atherosclerosis (group LAA). We studied about biomarkers on MRI such as two-layered SVS and abnormal finding patterns of diffusion-weighted image (DWI) for diagnosis of cardioembolic stroke in addition to laboratory data, physiological examination, and clinical findings.
  
  
  RESULTS
  In this study, 132 patients (72 men and 60 women, age 74.5 ± 12.1 years) were included. Of these, 63 (47.7%) were cardioembolic stroke. In univariate analysis, frequency of comorbid atrial fibrillation, presence of two-layered SVS on T2*-WI and that of single corticosubcortical infarct on DWI, intima-media thickness were significantly higher in group CE. In multivariate analysis, the presence of two-layered SVS and single corticosubcortical infarct were associated with cardioembolic stroke (odds ratio, two-layered SVS, 30.08, p<0.001; single corticosubcortical infarct, 15.78, p<0.001).
  
  
  CONCLUSIONS
  Biomarkers associated with cardioembolic stroke may be two-layered SVS on T2*-WI and single corticosubcortical infarct on DWI.
authors.affiliation: Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan. Electronic address: nobyamamoto521129@yahoo.co.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.affiliation: Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Yamaguchi
authors.affiliation: Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Furukawa
authors.affiliation: Department of Neurosurgery, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Radiology, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yuishin
authors.initials: Y
authors.lastname: Izumi
authors.affiliation: Department of Neurosurgery, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.affiliation: Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000209:etiology* / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications*; D002339:Carotid Arteries / Q000473:pathology; D016009:Chi-Square Distribution; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000209:etiology*
keywords: 3-T MRI; Diffusion-weighted image; SVS; Stroke subtype; T(2)*-weighted image; Two-layered SVS