Abstract
BackgroundGrowing data suggest that clot composition can impact revascularization outcomes and can potentially guide treatment strategies for stroke patients with large vessel occlusion. We performed an in vitro study to determine which magnetic resonance (MR) signaling characteristics correlate with clot compositions.MethodologyA total of 25 clot analogs were prepared by mixing human plasma and red blood cells (RBCs) with five different combinations (five samples for each combination), namely, Group A, fibrin-rich (95% plasma:5% RBCs); Group B, fibrin-rich (75% plasma:25% RBCs); Group C, intermediate (50% plasma:50% RBCs); Group D, RBC-rich (25% plasma:75% RBCs), and Group E, RBC-rich (5% plasma:95% RBCs). The prepared samples were then scanned with quantitative T2* mapping, T2 fast spin-echo (FSE), T2 gradient-echo (GRE), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN). Thrombus-T2* relaxation time (TT2*RT) and signal intensity (SI) from different scanning sequences were measured in all groups. SIs between different groups were compared using a one-way analysis of variance. Correlation between TT2*RT and SI was determined using the Pearson correlation test.ResultsThe average TT2*RT decreased from 126 ms to 37 ms from fibrin-rich to RBC-rich clots (Groups A to E). Mean SIs of Groups D and E were lower than Groups A, B, and C on T2 mapping, T2 FSE, T2 GRE, FLAIR, and SWAN images (p < 0.00001). TT2*RT and SI were positively correlated on T2 mapping (R = 0.9628, p = 0.009).ConclusionDifferent compositions of blood clots can show different TT2*RT and SI on MR imaging. Quantitative T2* mapping and multicontrast MR scanning can help in the characterization of clots causing large vessel occlusion, which is useful to establish treatment strategies for stroke patients.
Highlights
Clot composition can impact revascularization outcomes and strategies in stroke patients with large vessel occlusion
The blood clot mixtures were quickly loaded into 3 mL plastic Luer-Lock syringes, which were spun at 20 rounds per minute (RPM) in a hybridization incubator for one hour at 37°C to prevent the natural sedimentation of red blood cells (RBCs) in static conditions (Figure 1, Panels A-E) [3,4,5]
The difference in signal intensity (SI) between clots with lower (5-50%) and higher (75-95%) RBC content was significant on all comparisons, which indicated that the T2 fast spin-echo (FSE), T2 GRE, fluidattenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN) SI values decreased as the RBC content increased (Figure 3, Panels A-T)
Summary
Growing data suggest that clot composition can impact revascularization outcomes and can potentially guide treatment strategies for stroke patients with large vessel occlusion. We performed an in vitro study to determine which magnetic resonance (MR) signaling characteristics correlate with clot compositions
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