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European Radiology
Published in: European Radiology 3/2014

01-03-2014 | Neuro

Comparison of 3D multi-echo gradient-echo and 2D T2* MR sequences for the detection of arterial thrombus in patients with acute stroke

Authors: Jérôme Hodel, Xavier Leclerc, Wassef Khaled, Ruben Tamazyan, Mathieu Rodallec, Sophie Gerber, Raphael Blanc, Mohamed Benadjaoud, Oriane Lambert, Cécile Rabrait, Mathieu Zuber, Alain Rahmouni, Marc Zins

Published in: European Radiology | Issue 3/2014

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Abstract

Objectives

We compared a multi-echo gradient-echo magnetic resonance sequence (susceptibility-weighted angiography [SWAN]) with the T2* sequence for the detection of an arterial thrombus in acute ischaemic stroke.

Methods

Seventy-four consecutive patients with acute ischaemic stroke were included. Proximal arterial occlusions were diagnosed using time-of-flight (TOF) magnetic resonance angiography (MRA). Two-dimensional (2D) axial reformats from 3D SWAN were generated to match with 2D T2* images. For arterial thrombus detection, each set of MR images (T2*, 2D SWAN reformats and 3D multiplanar SWAN images) was examined independently and separately by three observers who assigned the images to one of three categories: (0) absence of thrombus, (1) uncertain thrombus, (2) certain thrombus. Agreement and diagnostic accuracy were calculated.

Results

Twenty-four proximal arterial occlusions involving the anterior (n = 20) or posterior (n = 4) circulation were found. Inter-observer agreement was moderate using T2* images (κ = 0.58), good using 2D SWAN reformats (κ = 0.83) and excellent using multiplanar SWAN images (κ = 0.90). For the diagnosis of thrombus, T2* images were 54 % sensitive and 86 % specific, 2D SWAN reformats were 83 % sensitive and 94 % specific and SWAN multiplanar analysis was 96 % sensitive and 100 % specific.

Conclusions

Three-dimensional SWAN sequence improves the detection of arterial thrombus in patients with acute ischaemic stroke in comparison with the 2D T2* sequence.

Key Points

• Multi-echo gradient-echo MR (e.g. susceptibility-weighted angiograph, [SWAN]) is increasingly used in neuroradiology.
• Compared with conventional T2* sequences, SWAN improves detection of arterial thrombus.
• Multiplanar SWAN analysis had the best diagnostic performance for arterial thrombus detection.
• Sensitivity was 96 % and specificity 100 %.
• Findings support combination of time-of-flight and susceptibility effects in suspected acute stroke.
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Metadata
Title
Comparison of 3D multi-echo gradient-echo and 2D T2* MR sequences for the detection of arterial thrombus in patients with acute stroke
Authors
Jérôme Hodel
Xavier Leclerc
Wassef Khaled
Ruben Tamazyan
Mathieu Rodallec
Sophie Gerber
Raphael Blanc
Mohamed Benadjaoud
Oriane Lambert
Cécile Rabrait
Mathieu Zuber
Alain Rahmouni
Marc Zins
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-3061-1

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