Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Morin Beyeler; Lorenz Grunder; Jayan Göcmen; Fabienne Steinauer; Nebiyat F Belachew; Moritz Kielkopf; Leander Clénin; Madlaine Mueller; Norbert Silimon; Christoph Kurmann; Thomas Meinel; Philipp Bücke; David Seiffge; Tomas Dobrocky; Eike I Piechowiak; Sara Pilgram-Pastor; Heinrich P Mattle; Babak B Navi; Marcel Arnold; Urs Fischer; Thomas Pabst; Jan Gralla; Martin D Berger; Simon Jung; Johannes Kaesmacher

doi:10.3389/fneur.2023.1148152

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Front Neurol. 2023 Mar 20:14:1148152. doi: 10.3389/fneur.2023.1148152. eCollection 2023.

Authors

Morin Beyeler^{1

2}, Lorenz Grunder³, Jayan Göcmen¹, Fabienne Steinauer¹, Nebiyat F Belachew⁴, Moritz Kielkopf¹, Leander Clénin¹, Madlaine Mueller¹, Norbert Silimon¹, Christoph Kurmann³, Thomas Meinel¹, Philipp Bücke¹, David Seiffge¹, Tomas Dobrocky³, Eike I Piechowiak³, Sara Pilgram-Pastor³, Heinrich P Mattle¹, Babak B Navi⁵, Marcel Arnold¹, Urs Fischer^{1

6}, Thomas Pabst⁷, Jan Gralla³, Martin D Berger⁷, Simon Jung¹, Johannes Kaesmacher³

Affiliations

¹ Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
² Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
³ Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
⁴ Department of Neuroradiology, University Hospital, Freiburg, Germany.
⁵ Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, United States.
⁶ Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
⁷ Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.

Abstract

Background and aim: Identification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.

Methods: SVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.

Results: Of the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45-6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73-13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54-2.11).

Conclusion: The absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.

Keywords: cancer-related stroke; hyperdense vessel sign; malignancy-related stroke; susceptibility vessel sign; thrombus imaging characteristics.

Copyright © 2023 Beyeler, Grunder, Göcmen, Steinauer, Belachew, Kielkopf, Clénin, Mueller, Silimon, Kurmann, Meinel, Bücke, Seiffge, Dobrocky, Piechowiak, Pilgram-Pastor, Mattle, Navi, Arnold, Fischer, Pabst, Gralla, Berger, Jung and Kaesmacher.