Abstract
In recent years, there has been substantial progression in the field of stroke clot/thrombus imaging. Thrombus imaging aims to deduce the histologic composition of the clot through evaluation of various imaging characteristics. If the histology of a thrombus can be reliably determined by noninvasive imaging methods, critical information may be extrapolated about its expected response to treatment and about the patient's clinical outcome. Crucially, as we move into an era of stroke therapy individualization, determination of the histologic composition of a clot may be able to guide precise and targeted therapeutic effort. Most radiologists, however, remain largely unfamiliar with the topic of clot imaging. This article will review the current literature regarding clot imaging, including its histologic backdrop, the correlation of images with cellular components and treatment responsiveness, and future expectations.
Highlights
Patel et al,[5] using a cohort of 40 patients treated with mechanical thrombectomy (MT), found that perviousness was associated with higher clot histologic percentages of both fibrin/platelet aggregates and was negatively correlated with the percentage of red blood cells (RBCs)
Clots that demonstrate an susceptibility vessel sign (SVS) have been shown to be richer in RBC composition, thought to be related to the paramagnetic properties of deoxygenated hemoglobin.[27]
On MR imaging, the presence of an SVS is predictive of higher rates of recanalization during MT and superior early clinical improvement, compatible with other results of RBC-rich clots.[34]
Summary
In the first major study to compare perviousness on CTA with histology, Berndt et al[23] found that pervious clots have greater fibrin/platelet conglomerations and less RBC fractions.
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