title: Cortical vessel sign on susceptibility weighted imaging reveals clinically relevant hypoperfusion in internal carotid artery stenosis.
abstract: OBJECTIVE
  Internal carotid artery (ICA) stenosis can lead to cerebral hypoperfusion and is a common cause of stroke. As susceptibility weighted imaging (SWI) has been used for penumbra imaging in acute ischemic stroke, we aimed at analyzing hypoperfusion using SWI in patients with ICA stenosis.
  
  
  METHODS
  Clinical characteristics, asymmetric cortical vessel sign (more and/or larger, hypointense asymmetric cortical vessels) on SWI, Doppler sonography results and diffusion weighted imaging (DWI) lesion volume were retrospectively analyzed in patients with ICA stenosis. In a subgroup of patients, volume of prolonged time to peak and volume of prolonged time to peak of the residue curve (Tmax) were measured as reference standard. Outcome was assessed as modified Rankin score at discharge.
  
  
  RESULTS
  104 patients were included. Median age was 72 and median degree of stenosis 70% according to NASCET. 13% had a asymmetric cortical vessel sign. These patients had a higher degree of stenosis (80% vs. 70%, p=0.004), were more often symptomatic (93% vs. 61%, p=0.020) and had higher DWI volume (7.3ml vs. 0.2ml, p=0.011). Specificity for the prediction of DWI lesions was 86%. Also, patients with asymmetric cortical vessel sign had lower rates of favorable outcome (mRS=0-2; 57% vs. 82%, p=0.033) and volumes of Tmax≥4s, ≥6s, ≥8s, ≥10s and TTP≥2s, ≥4s, ≥6s were significantly higher. In multivariate analysis, asymmetric cortical vessel sign was an independent negative predictor of favorable outcome (mRS 0-2; OR 0.184; CI [0.039; 0.875] p=0.033).
  
  
  CONCLUSIONS
  In patients with ICA stenosis, asymmetric cortical vessel sign is a sign of clinically relevant hypoperfusion.
authors: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Electronic address: sibu.mundiyanapurath@med.uni-heidelberg.de.
authors: Sibu
authors: S
authors: Mundiyanapurath
authors: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors: Peter A
authors: PA
authors: Ringleb
authors: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors: Sascha
authors: S
authors: Diatschuk
authors: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors: Sina
authors: S
authors: Burth
authors: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors: Markus
authors: M
authors: Möhlenbruch
authors: German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors: Ralf O
authors: RO
authors: Floca
authors: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; CCU Neurooncology, German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), INF 280, 69120 Heidelberg, Germany.
authors: Wolfgang
authors: W
authors: Wick
authors: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors: Martin
authors: M
authors: Bendszus
authors: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors: Alexander
authors: A
authors: Radbruch
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000473:pathology; D014463:Ultrasonography
keywords: Carotid artery stenosis; Hypoperfusion; Ischemic stroke; MR; Perfusion weighted imaging; Susceptibility weighted imaging