Fewer peripheral asymmetrical cortical veins is a predictor of favorable outcome in MCA infarctions with SWI‐DWI mismatch

Background Outcome prediction of asymmetrical prominent cortical veins (APCVs) on infarction is still debated and may help in selecting patients for reperfusion treatment. Purpose To explore the relationship between fewer peripheral APCVs and the outcome in the patients of acute/subacute middle cerebral artery (MCA) infarctions as well as the relationship between this sign and stenosis of ipsilateral MCA. Study Type Retrospective case–control study. Population We enrolled 41 patients with MCA acute/subacute infarction. Compared to the low sign of cortical veins of contralateral hemisphere on susceptibility‐weighted imaging (SWI), these patients were divided into fewer ( n = 28) and prominent APCVs ( n = 13) groups. Field Strength/Sequence 3.0T conventional stroke sequences, including T 1 ‐weighted imaging, T 2 ‐weighted imaging, fluid‐attenuated inversion recovery (FLAIR), diffusion‐weighted imaging (DWI) (b = 0 and 1000 s/mm 2 ), MR angiography (MRA), and SWI. Assessment We explored the relationships between fewer peripheral APCVs sign and clinical outcome, as well as the relationship between this sign and the degree of ipsilateral MCA stenosis. Statistical Tests Fisher's exact analysis, logistical regression, as well as Cohen's kappa coefficient were used for statistical analysis. Results Fewer and prominent peripheral APCVs were detected in 28 (56.10%) and 13 (43.90%) patients. In 28 patients with fewer peripheral APCVs, 23 patients (82.14%) had a favorable outcome (modified Rankin Scale [mRS] ≤2), and five patients (17.76%) had an unfavorable outcome (mRS >2) ( P = 0.010). In terms of MCA stenosis, the rate of normal and mild to moderate stenosis of MCA in the fewer APCVs group (82.14%) was higher than that in the prominent APCVs group (23.08%) ( P < 0.001). More severe stenosis of ipsilateral MCA was found in patients with prominent APCVs group (76.92%) than that of fewer APCVs group (17.86%). The peripheral APCVs was positively correlated with the degree of MCA stenosis ( r = 0.538, P < 0.001). Data Conclusion Fewer peripheral APCVs may suggest a favorable outcome in unilateral MCA infarction. The patency of ipsilateral MCA may correlate to fewer APCVs and favorable outcome. Level of Evidence: 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:964–970.