AUTHOR=Beyeler Morin , Belachew Nebiyat F. , Kielkopf Moritz , Aleman Enrique B. , León Betancourt Alejandro Xavier , Genceviciute Kotryna , Kurmann Christoph , Grunder Lorenz , Birner Barbara , Meinel Thomas R. , Scutelnic Adrian , Bücke Philipp , Seiffge David J. , Dobrocky Tomas , Piechowiak Eike I. , Pilgram-Pastor Sara , Mattle Heinrich P. , Mordasini Pasquale , Arnold Marcel , Fischer Urs , Pabst Thomas , Gralla Jan , Berger Martin D. , Jung Simon , Kaesmacher Johannes 

TITLE=Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.930635

DOI=10.3389/fneur.2022.930635

ISSN=1664-2295

ABSTRACT=Background and Purpose: Clots rich in platelets and fibrin retrieved from patients with acute ischemic stroke (AIS) have been shown to be independently associated with the absence of the susceptibility vessel sign (SVS) on MRI and active malignancy. This study analyzed the association of SVS and the presence of active malignancy in AIS patients who underwent mechanical thrombectomy (MT). 
Methods: This single-center, retrospective and cross-sectional study included consecutive AIS patients with admission MRI treated with MT between January 2010 and December 2018. SVS status was evaluated on susceptibility-weighted imaging. Adjusted odds ratios (aOR) were calculated to determine the association between absent SVS and the presence of active or occult malignancy. The performance of predictive models incorporating and excluding SVS status were compared using areas under the receiver operating characteristics curve (auROC).
Results: Of 577 AIS patients with assessable SVS status, 40 (6.9%) had a documented active malignancy and 72 (12.5%) showed no SVS. The absence of SVS was associated with active malignancy (aOR 4.85, 95% CI 1.94–12.11) or occult malignancy (aOR 11.42, 95% CI 2.36–55.20). The auROC of predictive models, including demographics and common malignancy biomarkers, was higher but not significant (0.85 vs 0.81, P=0.07) when SVS status was included. 
Conclusions: Absence of SVS on admission MRI of AIS patients undergoing MT is associated with malignancy, regardless of whether known or occult. Therefore, the SVS might be helpful to detect paraneoplastic coagulation disorders and occult malignancy in AIS patients.