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Original research
Quantitative estimation of thrombus-erythrocytes using MRI. A phantom study with clot analogs and analysis by statistic regression models
  1. Kevin Janot1,
  2. Tiago Ribeiro Oliveira2,
  3. Gaelle Fromont-Hankard3,
  4. Mariam Annan4,
  5. Isabelle Filipiak5,
  6. Laurent Barantin5,
  7. Roseline Guibon3,
  8. Sharon Duffy6,
  9. Michael Gilvarry6,
  10. Jean-Philippe Cottier1,
  11. Ana Paula Narata1
  1. 1 Neuroradiology, Regional University Hospital Centre Tours, Tours, France
  2. 2 Center for Engineering, Modeling and Applied Social Sciences, Federal University of the ABC, Sao Bernardo do Campo, Brazil
  3. 3 Pathology, Regional University Hospital Centre Tours, Tours, France
  4. 4 Neurology, Regional University Hospital Centre Tours, Tours, France
  5. 5 Inserm U1253 ’Imaging and Brain: iBrain'', Regional University Hospital Centre Tours, Tours, France
  6. 6 Cerenovus, Galway Neuro Technology Centre, Galway, Ireland
  1. Correspondence to Dr Tiago Ribeiro Oliveira, Center for Engineering, Modeling and Applied Social Sciences, Federal University of the ABC, Santo André 09210-580, Brazil; tiago.ribeiro{at}


Background Thrombus composition has the potential to affect acute ischemic stroke (AIS) treatment.

Objective To evaluate in an in vitro test the correlation of clot composition, especially erythrocytes (red blood cells (RBCs)), with the variation of signal intensity ratio (SIR) obtained with MRI sequences used for AIS, and qualification of the susceptibility vessel sign effect using clot analogs.

Materials and methods Nine ovine clots were fixed in a gelatin-manganese solution and studied by MRI (T2GE, T2-weighted gradient echo; SWI, susceptibility-weighted imaging; FLAIR, fluid attenuated inversion recovery). RBC concentration was estimated using regression models (SLR, single linear regression; MLR, multiple linear regression; RF, random Forest; and ANN, artificial neural networking), which combined the SIR–histology relationship of three MRI sequences.

Results Negative correlation was found between SIR and RBC concentration. T2GE SWI could not statistically distinguish clots with RBC content >54% and <23%. SLR was applied only to FLAIR images since T2GE and SWI demonstrated signal saturation. All four regression models showed a correlation between MRI and histology: SLR=0.981; MLR=0.986; RF=0.994, and ANN=0.971. One unknown clot was studied and agreement between SIR and histological analyses was found in all models.

Conclusions We presented a method to quantify RBC concentration in clot analogs, combining SWI, T2GE, and FLAIR. This in vitro study has some limitations, so clot collection after thrombectomy with simultaneous imaging analysis is necessary to validate this model.

  • stroke
  • Mri
  • thrombectomy

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  • Contributors APN and KJ conceived the idea, designed the paper, and wrote the manuscript. TRO, IF, LB, and KJ were involved in the experimental conception, data collection, and analysis. TRO performed the statistical analysis. GF-H, RG, and SD were involved in histological analysis. All authors provided suggestions and feedback on the manuscript, and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.