Susceptibility Vessel Sign as a Predictor of Intracranial Large Vessel Occlusion

Background The susceptibility vessel sign (SVS), which can be seen on susceptibility-weighted imaging (SWI), is typically described as a dark blooming artifact. Objective SVS, which can be seen on T2*-weighted gradient echo imaging, is typically described as a dark blooming artifact. The hypointense vessel’s diameter is thus larger on imaging than the opposing vessel’s diameter. We conducted a study to investigate the reliability of this sign on SWI in the principal intracranial arteries in 156 individuals with acute stroke and to assess the 3-month outcome using the modified Rankin Scale (mRS) in these patients. Results Among the 106 patients with large vessel occlusion (LVO) on magnetic resonance angiography (MRA), 73 patients demonstrated a positive SVS on magnetic resonance imaging (MRI), while 33 patients did not. Among the 50 patients without LVO, only 4 patients showed a false-positive SVS, while 46 patients showed a negative SVS. The sensitivity, specificity, positive predictive value, and negative predictive value of SVS as a screening tool were 67.05%, 90.7%, 93.65%, and 57.35% in anterior circulation LVO, and 77.8%, 100%, 100%, and 63.6% in posterior circulation LVO, respectively. The chi-square test showed p < .05, demonstrating a significant association. With a modified thrombolysis in cerebral infarction (mTICI) score of 2B or 3, 83.3% of SVS-positive patients had a successful recanalization, while 64.4% had an mRS score of less than 3. Interpretation SVS is a good screening tool for the presence of intracranial LVO, with good sensitivity, high specificity, and positive predictive value for LVO (posterior > anterior). SVS positivity may also indicate successful recanalization and a good 90-day mRS outcome.