Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke.
OBJECTIVE
To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke.


METHODS
Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined.


RESULTS
Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k = 0.314-0.338, p ≤ 0.001) for grading, and moderate agreement (k = 0.406-0.413, p ≤ 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho = 0.232, p = 0.001; rho = 0.180, p = 0.008; respectively) and larger infarct volume (rho = 0.445, p < 0.001; rho = 0.167, p = 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p = 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p < 0.001).


CONCLUSIONS
There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Seyedmehdi
http://orcid.org/0000-0003-4628-0370
S
Payabvash
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
John C
JC
Benson
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Shayandokht
S
Taleb
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Jeffrey B
JB
Rykken
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.|2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
Benjamin
B
Hoffman
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.|2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
Mark C
MC
Oswood
1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.|2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
Alexander M
AM
McKinney
D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000473:pathology*