Asymmetrical cortical vessel sign on susceptibility-weighted imaging: a novel imaging marker for early neurological deterioration and unfavorable prognosis

Eur J Neurol. 2014 Nov;21(11):1411-8. doi: 10.1111/ene.12510. Epub 2014 Jul 10.


Background and purpose: Susceptibility-weighted imaging (SWI) is a high spatial resolution technique that can indirectly demonstrate increased cerebral oxygen extraction. Our aim was to assess whether asymmetric cortical vessel sign (ACVS) on SWI could be associated with early neurological deterioration (END) as well as 90-day unfavorable outcome in patients with acute ischaemic stroke.

Materials and methods: Consecutive patients with acute middle cerebral artery (MCA) territory infarction were prospectively enrolled. ACVS was defined as more and/or larger vessels with greater signal loss than those in the opposite hemisphere on minimum intensity projection of SWI. The neurofunctional fluctuation during acute phase as well as 90-day outcomes were assessed. A National Institutes of Health Stroke Scale increment ≥2 points and ≥4 points despite standard treatment in the first 72 h after admission was defined as END2 and END4, respectively.

Results: In all, 572 patients were finally enrolled. ACVS on SWI was present in 39 (6.8%) subjects. Multivariate analysis indicated that ACVS is an independent predictor for END2 [odds ratio (OR) 4.47, 95% confidence interval (CI) 1.99-10.05) and END4 (OR 4.24, 95% CI 1.94-9.23). Furthermore, ACVS also correlates with 90-day unfavorable outcome defined as a modified Rankin Scale score >1 point (OR 2.93, 95% CI 1.15-7.48). Both positive and negative predictive values of ACVS for END2, END4 and 90-day prognosis were reasonable and both could be slightly enhanced as long as patients with contralateral artery stenosis or occlusion were excluded.

Conclusion: In patients with MCA territory acute ischaemic stroke, especially in those without contralateral internal carotid artery/MCA stenosis or occlusion, ACVS might be considered as a neuroimaging predictor for END and unfavorable prognosis.

Keywords: asymmetric cortical vessel sign; early neurological deterioration; ischaemic stroke; susceptibility-weighted imaging.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / pathology
  • Infarction, Middle Cerebral Artery / physiopathology
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Imaging / standards
  • Male
  • Middle Aged
  • Neuroimaging / methods*
  • Neuroimaging / standards
  • Predictive Value of Tests
  • Prognosis


  • Biomarkers