Are prominent medullary veins better than prominent cortical veins as predictors of early clinical outcome in patients with acute ischemic stroke?

The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. Forty-seven consecutive patients with AIS within the middle cerebral artery territory were recruited. Magnetic resonance imaging was performed within 8 hours of symptom onset and at 7 days after stroke onset. Infarct volume was measured, and the early clinical outcome at 7 days was assessed using the modified Rankin Scale. PVS was dichotomized into cases with both PCV and PMV and cases with only PCV according to location. Patients with both PCV and PMV (n=32) had higher admission National Institutes of Health Stroke Scale scores (p = 0.020), larger infarct volumes at baseline (p = 0.026) and 7 days (p = 0.007), and larger infarct growth at 7 days (p = 0.050) than those with PCV only. Multivariate regression analysis showed that both the time of onset at baseline (p = 0.013) and infarct growth at 7 days (p = 0.014) could independently predict poor early clinical outcome. PMV may predict poor early clinical outcome in AIS patients, and reperfusion therapy may, therefore, be required more urgently in patients with PMV.