Use of 3-Dimensional, Black-Blood, Contrast-Enhanced, T1-Weighted Magnetic Resonance Imaging to Identify Vascular Occlusion in the Posterior Circulation After Acute Ischemic Stroke

Background: Three-dimensional, black-blood, contrast-enhanced, T1-weighted magnetic resonance imaging (3D-BB-ceT1-MRI) could play a role in detection of thrombi and symptomatic intracranial atherosclerotic stenosis. We investigated the role of 3D-BB-ceT1-MRI in patients with acute ischemic stroke in the posterior circulation, and compared our findings with those from susceptibility-weighted imaging (SWI). Materials and Methods: We retrospectively reviewed 3D-BB-ceT1-MRI for patients between January 2017 and August 2018 with acute ischemic symptoms in the posterior circulation. During this period, 199 patients with acute infarction in the posterior circulation were enrolled. Time-of-flight-magnetic resonance angiography or cerebral angiography was used as the reference standard. Results: Of these 199 patients, 47 had vessel occlusion associated with acute infarction. The sensitivity of 3D-BB-ceT1-MRI for detection of vessel occlusion was significantly higher than that of SWI (95.7% versus 53.2%, P < .001). Twenty-one lesions with strong enhancement on 3D-BB-ceT1-MRI showed a negative susceptibility vessel sign (SVS) on SWI. Conclusions: 3D-BB-ceT1-MRI showed strong enhancement (due to contrast stagnation) in the intra-arterial thrombi of patients with acute infarction in the posterior circulation. 3D-BB-ceT1-MRI had higher sensitivity than that of an SVS on SWI for detection of intra-arterial thrombi.