Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke

Objectives: This study evaluated the utility of three-dimensional (3D), black-blood (BB), contrast-enhanced, magnetic resonance imaging (MRI) for the detection of intraluminal thrombi in acute stroke patients. Methods: Forty-seven patients with acute stroke involving the anterior circulation underwent MRI examination within 6 h of clinical onset. Cerebral angiography was used as the reference standard. In a blinded manner, two neuroradiologists interpreted the following three data sets: (1) diffusion-weighted imaging (DWI) + 3D BB contrast-enhanced MRI; (2) DWI + susceptibility weighted imaging (SWI); (3) DWI + 3D BB contrast-enhanced MRI + SWI. Results: Of these patients, 47 had clots in the middle cerebral artery and four had clots in the anterior cerebral artery. For both observers, the area under the curve (Az) for data sets 1 and 3, which included 3D BB contrast-enhanced MRI, was significantly greater than it was for data set 2, which did not include 3D BB contrast-enhanced MR imaging (observer 1, 0.988 vs 0.904, p = 0.001; observer 2, 0.988 vs 0.894, p = 0.000). Conclusions: Three-dimensional BB contrast-enhanced MRI improves detection of intraluminal thrombi compared to conventional MRI methods in patients with acute ischaemic stroke. Key Points: • BB contrast-enhanced MRI helps clinicians to assess the intraluminal clot • BB contrast-enhanced MRI improves detection of intraluminal thrombi • BB contrast-enhanced MRI for clot detection has a higher sensitivity.