Comparison of imaging findings on three-dimensional black-blood enhanced MR imaging between intracranial atherosclerotic occlusion and thrombotic occlusion



      The purpose of this study was to compare the imaging findings on three-dimensional (3D) black-blood (BB) contrast-enhanced MR imaging between intracranial atherosclerotic occlusion (IAO) and thrombotic occlusion (TO) of the middle cerebral artery (MCA) territory.

      Materials and methods

      From August 2020 to September 2021, we retrospectively reviewed the BB contrast-enhanced MR imaging of patients visiting the emergency room for evaluation of acute ischemic stroke. In total, 77 patients with complete occlusion of the MCA territory on 3D BB contrast-enhanced MR imaging and cerebral angiography were enrolled in this study. We divided the IAO and TO groups according to occlusion causes based on angiography findings.


      Of 77 patients, 44 (57.1%) had an IAO in the M1 and M2 and 33 had a TO. Lesion length contrast enhancement (CE) in patients with a TO was significantly longer than that in patients with an IAO (18.95 mm [IQR: 20.91] vs. 7.1 mm [8.92], p <0.001). Overall, 38 (39.4%) patients showed a disconnection of CE on 3D BB contrast-enhanced MR imaging, and 35 showed CE before and after the stenotic or thrombotic lesion. Symptomatic lesions on diffusion-weighted imaging in the TO group were significantly higher than that of the IAO group (97.0% vs, 70.5%, p = 0.003).


      The long segment CE on 3D BB contrast-enhanced MR imaging was related to TO of MCA. CE before and after a stenotic or thrombotic lesion is a common finding on 3D BB contrast-enhanced MR imaging.

      Key Words


      IAO (intracranial atherosclerotic occlusion), TO (thrombotic occlusion), BB (black blood), CE (contrast enhancement)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mukherjee D.
        • Patil C.G.
        Epidemiology and the global burden of stroke.
        World Neurosurg. 2011; 76: S85-S90
        • Derex L.
        • Nighoghossian N.
        • Hermier M.
        • Adeleine P.
        • Froment J.C.
        • Trouillas P.
        Early detection of cerebral arterial occlusion on magnetic resonance angiography: predictive value of the baseline NIHSS score and impact on neurological outcome.
        Cerebrovasc Dis. 2002; 13: 225-229
        • Legrand L.
        • Naggara O.
        • Turc G.
        • Mellerio C.
        • Roca P.
        • Calvet D.
        • Labeyrie M.A.
        • Baron J.C.
        • Mas J.L.
        • Meder J.F.
        • Touzé E.
        • Oppenheim C.
        Clot burden score on admission T2*-MRI predicts recanalization in acute stroke.
        Stroke. 2013; 44: 1878-1884
        • Cho K.H.
        • Kim J.S.
        • Kwon S.U.
        • Cho A.H.
        • Kang D.W.
        Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes.
        Stroke. 2005; 36: 2379-2383
        • Radbruch A.
        • Mucke J.
        • Schweser F.
        • Deistung A.
        • Ringleb P.A.
        • Ziener C.H.
        • Roethke M.
        • Schlemmer H.P.
        • Heiland S.
        • Reichenbach J.R.
        • Bendszus M.
        • Rohde S.
        Comparison of susceptibility weighted imaging and TOF-angiography for the detection of Thrombi in acute stroke.
        PLoS One. 2013; 8: e63459
        • Park M.G.
        • Oh S.J.
        • Baik S.K.
        • Jung D.S.
        • Park K.P.
        Susceptibility-weighted imaging for detection of thrombus in acute cardioembolic stroke.
        J Stroke. 2016; 18: 73-79
        • Ota H.
        • Yarnykh V.L.
        • Ferguson M.S.
        • Underhill H.R.
        • Demarco J.K.
        • Zhu D.C.
        • Oikawa M.
        • Dong L.
        • Zhao X.
        • Collar A.
        • Hatsukami T.S.
        • Yuan C.
        Carotid intraplaque hemorrhage imaging at 3.0-T MR imaging: comparison of the diagnostic performance of three T1-weighted sequences.
        Radiology. 2010; 254: 551-563
        • Takaya N.
        • Yuan C.
        • Chu B.
        • Saam T.
        • Underhill H.
        • Cai J.
        • Tran N.
        • Polissar N.L.
        • Isaac C.
        • Ferguson M.S.
        • Garden G.A.
        • Cramer S.C.
        • Maravilla K.R.
        • Hashimoto B.
        • Hatsukami T.S.
        Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI–initial results.
        Stroke. 2006; 37: 818-823
        • Yuan C.
        • Hatsukami T.S.
        • Obrien K.D.
        High-Resolution magnetic resonance imaging of normal and atherosclerotic human coronary arteries ex vivo: discrimination of plaque tissue components.
        J Investig Med. 2001; 49: 491-499
        • Yuan C.
        • Mitsumori L.M.
        • Ferguson M.S.
        • Polissar N.L.
        • Echelard D.
        • Ortiz G.
        • Small R.
        • Davies J.W.
        • Kerwin W.S.
        • Hatsukami T.S.
        In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques.
        Circulation. 2001; 104: 2051-2056
        • Baik S.H.
        • Kwak H.S.
        • Hwang S.B.
        • Chung G.H.
        Three-dimensional black blood contrast enhanced magnetic resonance imaging in patients with acute ischemic stroke and negative susceptibility vessel sign.
        Eur J Radiol. 2018; 102: 188-194
        • Jang W.
        • Kwak H.S.
        • Chung G.H.
        • Hwang S.B.
        Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke.
        Eur Radiol. 2018; 28: 3840-3847
        • Chung G.H.
        • Hwang S.B.
        • Kwak H.S.
        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.
        J Stroke Cerebrovasc Dis. 2019; 28104373
        • Wang J.
        • Gerretsen S.C.
        • Maki J.H.
        • Jaarsma C.
        • Kooi M.E.
        • Herzka D.
        • Chu B.
        • Yarnykh V.L.
        • Yuan C.
        • Leiner T.
        Time-efficient black blood RCA wall imaging at 3T using improved motion sensitized driven equilibrium (iMSDE): feasibility and reproducibility.
        PLoS One. 2011; 6: e26567
        • Wang J.
        • Yarnykh V.L.
        • Yuan C.
        Enhanced image quality in black-blood MRI using the improved motion-sensitized driven-equilibrium (iMSDE) sequence.
        J Magn Reson Imaging. 2010; 31: 1256-1263
        • Wu F.
        • Ma Q.
        • Song H.
        • Guo X.
        • Diniz M.A.
        • Song S.S.
        • Gonzalez N.R.
        • Bi X.
        • Ji X.
        • Li D.
        • Yang Q.
        • Fan Z.
        Differential features of culprit intracranial atherosclerotic lesions: a whole-brain vessel wall imaging study in patients with acute ischemic stroke.
        J Am Heart Assoc. 2018; 7
        • Yang Q.
        • Deng Z.
        • Bi X.
        • Song S.S.
        • Schlick K.H.
        • Gonzalez N.R.
        • Li D.
        • Fan Z.
        Whole-brain vessel wall MRI: a parameter tune-up solution to improve the scan efficiency of three-dimensional variable flip-angle turbo spin-echo.
        J Magn Reson Imaging. 2017; 46: 751-757
        • Gang M.
        • Lee H.
        • Kwak H.S.
        • Hwang S.B.
        • Chung G.H.
        Strong enhancement on three-dimensional black-blood enhanced magnetic resonance imaging: comparison intracranial stenosis and complete occlusion.
        Eur J Radiol. 2021; 137109580
        • Al-Smadi A.S.
        • Abdalla R.N.
        • Elmokadem A.H.
        • Shaibani A.
        • Hurley M.C.
        • Potts M.B.
        • Jahromi B.S.
        • Carroll T.J.
        • Ansari S.A.
        Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions.
        AJNR Am J Neuroradiol. 2019; 40: 954-959
        • Chen Q.
        • Wang W.
        • Chen Y.C.
        • Chen G.
        • Ni L.
        • Zhang D.
        • Zhou J.
        • Yin X.D.
        Peri-thrombus vascular hyperintensity sign: detection of intracranial thrombus location and length in acute ischemic stroke.
        Jpn J Radiol. 2020; 38: 516-523
        • Duron L.
        • Savatovsky J.
        • Obadia M.
        • Metten M.A.
        • Roux P.
        • Blanc R.
        • Sadik J.C.
        • Dhundass S.
        • Lecler A.
        Magnetic resonance post-contrast vascular hyperintensities at 3 T: a new highly sensitive sign of vascular occlusion in acute ischaemic stroke.
        Eur Radiol. 2018; 28: 2903-2913
        • Lee K.Y.
        • Suh S.H.
        • Ahn S.J.
        Significance of hyperintense arteries on Gd-enhanced 3D T1W black-blood imaging in acute stroke.
        Eur Radiol. 2019; 29: 1329-1337
        • Ahn S.J.
        • Lee K.Y.
        • Ahn S.S.
        • Suh H.
        • Kim B.S.
        • Lee S.K.
        Can FLAIR hyperintense vessel (FHV) signs be influenced by varying MR parameters and flow velocities? A flow phantom analysis.
        Acta Radiol. 2016; 57: 580-586
        • Ahn S.J.
        • Suh S.H.
        • Lee K.Y.
        • Kim J.H.
        • Seo K.D.
        • Lee S.
        Hyperintense vessels on T2-PROPELLER-FLAIR in patients with acute MCA stroke: prediction of arterial stenosis and perfusion abnormality.
        AJNR Am J Neuroradiol. 2015; 36: 2042-2047
        • Lee S.H.
        • Seo K.D.
        • Kim J.H.
        • Suh S.H.
        • Ahn S.J.
        • Lee K.Y.
        Correlation between hyperintense vessels on FLAIR imaging and arterial circulation time on cerebral angiography.
        Magn Reson Med Sci. 2016; 15: 105-110
        • Cosnard G.
        • Duprez T.
        • Grandin C.
        • Smith A.M.
        • Munier T.
        • Peeters A.
        Fast FLAIR sequence for detecting major vascular abnormalities during the hyperacute phase of stroke: a comparison with MR angiography.
        Neuroradiology. 1999; 41: 342-346
        • Kamran S.
        • Bates V.
        • Bakshi R.
        • Wright P.
        • Kinkel W.
        • Miletich R.
        Significance of hyperintense vessels on FLAIR MRI in acute stroke.
        Neurology. 2000; 55: 265-269