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Progression of Middle Cerebral Artery Susceptibility Sign on T2*-Weighted Images: Its Effect on Recanalization and Clinical Outcome After Thrombolysis

Ho Sung Kim1, Deok Hee Lee1, Choong Gon Choi1, Sang Joon Kim1 and Dae Chul Suh1

1 All authors: Department of Radiology, Division of Neuroradiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea.


Figure 1
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  		Fig. 1A —63-year-old man with acute left-sided hemiparesis. T2*-weighted gradient-echo axial image shows positive susceptibility sign (arrow) from proximal to mid portions of right middle cerebral artery (MCA).

 

Figure 2
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  		Fig. 1B —63-year-old man with acute left-sided hemiparesis. Initial 3D time-of-flight (TOF) (B) and 3D contrast-enhanced (C) MR angiography images obtained before intraarterial (IA) thrombolytic treatment show proximal M1 occlusion (arrow, C) of MCA.

 

Figure 3
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  		Fig. 1C —63-year-old man with acute left-sided hemiparesis. Initial 3D time-of-flight (TOF) (B) and 3D contrast-enhanced (C) MR angiography images obtained before intraarterial (IA) thrombolytic treatment show proximal M1 occlusion (arrow, C) of MCA.

 

Figure 4
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  		Fig. 1D —63-year-old man with acute left-sided hemiparesis. Diffusion-weighted image obtained before treatment shows acute infarct in right MCA territory.

 

Figure 5
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  		Fig. 1E —63-year-old man with acute left-sided hemiparesis. Anteroposterior internal carotid angiogram obtained before thrombolytic treatment shows right proximal MCA occlusion (arrow).

 

Figure 6
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  		Fig. 1F —63-year-old man with acute left-sided hemiparesis. Anteroposterior internal carotid angiogram obtained after administration of IA urokinase (200,000 IU) shows complete recanalization (thrombolysis in myocardial infarction [TIMI] flow grade, 3) of right proximal MCA.

 

Figure 7
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  		Fig. 1G —63-year-old man with acute left-sided hemiparesis. Follow-up T2*-weighted MR image obtained 2 days after IA thrombolysis shows susceptibility sign is no longer present, and this finding is confirmed on H.

 

Figure 8
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  		Fig. 1H —63-year-old man with acute left-sided hemiparesis. Follow-up 3D TOF MR angiography image shows finding in G correlates well with complete recanalization of right MCA.

 

Figure 9
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  		Fig. 2A —52-year-old woman with acute right-sided weakness. T2*-weighted gradient-echo axial image obtained before treatment shows positive susceptibility sign (arrow).

 

Figure 10
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  		Fig. 2B —52-year-old woman with acute right-sided weakness. Initial 3D time-of-flight (TOF) (B) and 3D contrast-enhanced (C) MR angiography images obtained before intraarterial (IA) thrombolytic treatment show occlusion of mid M1 portion of left middle cerebral artery (MCA).

 

Figure 11
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  		Fig. 2C —52-year-old woman with acute right-sided weakness. Initial 3D time-of-flight (TOF) (B) and 3D contrast-enhanced (C) MR angiography images obtained before intraarterial (IA) thrombolytic treatment show occlusion of mid M1 portion of left middle cerebral artery (MCA).

 

Figure 12
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  		Fig. 2D —52-year-old woman with acute right-sided weakness. Anteroposterior internal carotid angiogram obtained immediately after IA urokinase administration (350,000 IU) shows no change of complete occlusion (thrombolysis in myocardial infarction [TIMI] flow grade, 0) in mid M1 portion of left MCA.

 

Figure 13
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  		Fig. 2E —52-year-old woman with acute right-sided weakness. Follow-up T2*-weighted MR image obtained 2 days after IA thrombolysis shows susceptibility sign is no longer present and reveals hemorrhagic transformation (arrow).

 

Figure 14
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  		Fig. 2F —52-year-old woman with acute right-sided weakness. Findings shown in E are well correlated with complete recanalization of left MCA on follow-up 3D TOF (F) and contrast-enhanced (G) MR angiography images.

 

Figure 15
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  		Fig. 2G —52-year-old woman with acute right-sided weakness. Findings shown in E are well correlated with complete recanalization of left MCA on follow-up 3D TOF (F) and contrast-enhanced (G) MR angiography images.

 

Figure 16
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  		Fig. 3A —38-year-old man with acute right-sided weakness. T2*-weighted gradient-echo axial image shows negative susceptibility sign.

 

Figure 17
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  		Fig. 3B —38-year-old man with acute right-sided weakness. Initial 3D time-of-flight (TOF) MR angiography image obtained before intraarterial (IA) thrombolytic treatment shows occlusion of proximal M1 portion of left middle cerebral artery (MCA).

 

Figure 18
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  		Fig. 3C —38-year-old man with acute right-sided weakness. Anteroposterior internal carotid angiogram obtained before thrombolytic treatment shows left proximal MCA occlusion (arrow).

 

Figure 19
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  		Fig. 3D —38-year-old man with acute right-sided weakness. Anteroposterior internal carotid angiogram obtained immediately after administration of IA urokinase (600,000 IU) shows poor recanalization (thrombolysis in myocardial infarction [TIMI] flow grade, 1) of left proximal MCA.

 

Figure 20
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  		Fig. 3E —38-year-old man with acute right-sided weakness. Follow-up 3D TOF MR angiography image obtained 2 days after IA thrombolysis shows partial recanalization with residual stenosis in proximal M1 portion of left MCA.

 

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