Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke

Table 1 Publications using T2*w sequences

Ref.	n	Field strength	Occluded vessel	Time from onset	Validation method	Results
Hermier et al[7]	49	1.5 T	Anterior circulation	6 h	DWI; DSC-MRI	AVV obvious in 8/49, moderate in 15/49 patients, inter- and intra-observer reliability r > 0.9; Correlated with higher baseline NIHSS, larger DWI and PWI lesions, worse outcome, intracranial haemorrhage and more severe hemodynamic impairment
Liebeskind et al[8]	91	NS	MCA	NS	MRA; DWI	Hypointense vessels in or adjacent to the infarct in 40/91 patients
Liebeskind et al[9]	83	NS	MCA	Median 2 d	MRA	Unilateral hypointensity of the basal vein of Rosenthal was noted in 27/83 patients on the side of the occlusion
Hermier et al[10]	48	1.5 T	NS	6 h	DWI; DSC-MRI	AVLV present in 17/48 patients, within TTP lesion, not concordant with DWI lesion; No impact on clinical status and final stroke volume
Seo et al[11]	20	3 T	ICA, MCA	6 h	DSC-MRI; DWI	HVS present in 13/20 patients. Patients with asymmetrical HVS had better NIHSS improvement (8.1 ± 5.7 vs 2 ± 4.2)
Sohn et al[12]	86	NS	ICA, MCA	12 h	DSC-MRI; DWI	Present in 59/86 patients; HypoTCV associated with large perfusion defect, but low cholesterol and haemoglobin level may obscure its visibility
Ha et al[13]	22	3 T	MCA	6 h	DSA	Present in 7/22 patients. Patients with HLV showed larger baseline NIHSS (16.9 ± 3.4 vs 11.7 ± 5.3) and major improvement (≥ 8 points) was observed more often. It corresponded with delayed venous wash-out on DSA
Morita et al[14]	24	3 T	ICA, MCA	12 h	DWI; FAIR	CVS present in all patients, BS present in 23/24 patients, good interobserver agreement (κ = 0.7). Area defined by CVS/BS similar to hypoperfused area
Harada et al[15]	24	3 T	NS	12 h	FAIR; DWI	κ for cortical and deep vessel signs 0.84 and 0.72, respectively
Ha et al[16]	35	NS	MCA	6 h	DSC-MRI; DWI; DSA	HLV present in 12/35 patients. Patients with HLV had larger NIHSS improvement at 7 d (6.5 ± 4.6 d vs 0.5 ± 6.7 d) and bigger TTP-DWI mismatch. HLV corresponded with delayed venous wash-out
Kaya et al[17]	20	3 T	Large arteries	3 h	DWI; DSC-MRI	Present in all patients. Very good correlation of RMHV with final infarct (r = 0.91) and MTT/rCBV lesion (r = 0.96); very high interobserver correlation (ICC = 0.99)
Kinoshita et al[18]	NS (case series)	1.5 T	NS	NS	15O-PET	Enhanced venous contrast (hypointensity and enlargement of veins), ipsilateral corresponding increased OEF
Harada et al[19]	33	3 T	ICA, MCA	3 h	FAIR; DWI	IschV present in 79% (κ = 0.83); Not correlated with worse outcome
Tada et al[20]	2	3 T	MCA (stenosis)	NS	DWI; DSC-MRI; 123I-IMP SPECT	Area defined by ischemic signs was similar to area of hypoperfusion on MRI and SPECT
Rosso et al[21]	60	3 T	Anterior circulation	6 h	DWI; MRI	VTV present in 58.3% (κ = 0.895), correlated with larger infarcts and haemorrhage but not with baseline or follow-up NIHSS
Ryoo et al[22]	30	NS	ICA, MCA	6 h	Clinical	GRE vein present in 15/30 patients. Early neurological improvement (ΔNIHSS ≥ 8 or NIHSS ≤ 2 at 24 h) more frequently observed with GRE vein (8 patients vs 1 patients, P = 0.014)

NS: Not stated; ICA: Internal carotid artery; MCA: Middle cerebral artery; DWI: Diffusion-weighted image; DSC-MRI: Dynamic susceptibility-contrast magnetic resonance imaging; MRA: Magnetic resonance angiography; AVV: Abnormal visibility of transcerebral veins; PWI: Perfusion-weighted image; AVLV: Abnormal visualization of leptomeningeal vessels; TTP: Time to peak; CVS: Cerebral vasospasm; BS: Brush sign; HVS: Hyperintense vessel sign; HLV: Hypointense leptomeningeal vessels;

¹⁵O-PET: Oxygen-15 positron emission tomography; CT: Computed tomography; HypoTCV: Hypointense transcerebral or cortical veins; FAIR: Flow sensitive alternating inversion recovery;

¹²³I-IMP SPECT: Iodine-123 iodoamphetamine single-photon emission computed tomography; DSA: Digital subtraction angiography; NIHSS: National Institute of Health Stroke Score; RMHV: Region of multiple hypointense vessels; MTT: Mean transit time; rCBV: Relative cerebral blood volume; ICC: Intraclass correlation; OEF: Oxygen extraction fraction; VTV: Visibility of the transcerebral veins; GRE: Gradient-echo.