Journal Mobile Options
Table of Contents
Vol. 68, No. 4, 2012
Issue release date: October 2012
Eur Neurol 2012;68:214–220

Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

Huang X. · Liu W. · Zhu W. · Ni G. · Sun W. · Ma M. · Zhou Z. · Wang Q. · Xu G. · Liu X.
aDepartment of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, bDepartment of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, and cDepartment of Neurology, Jinling Hospital, Southern Medical University, Guangzhou, and dDepartment of Neurology, Affiliated Shenzhen Shajing Hospital of Guangzhou Medical University (Shajing People’s Hospital), Shenzhen , China

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Hyperintense vessels (HVs) on fluid-attenuated inversion recovery (FLAIR) are frequently observed in acute ischemic stroke (AIS). The presence of HVs represents altered blood flow from collaterals distal to arterial occlusion or stenosis. This study aimed to evaluate the prognostic value of HVs in AIS. Methods: Fifty-four consecutive patients with acute middle cerebral artery occlusion were enrolled in the study. The location and extent of the HVs was determined by FLAIR. Clinical data were obtained and compared between patients with different grades of HVs. Additionally, the relationship between distal HVs and leptomeningeal collaterals (LMCs) was assessed using angiography. Results: HVs were observed in 41 (75.9%) of the 54 patients enrolled. The initial NIHSS score was lower (p < 0.001) and the infarction volume was smaller (p < 0.001) in patients with distal HVs. Adjusting of other factors, regression analysis revealed that distal HVs are an independent predictor of a favorable outcome at 90 days (p = 0.006; OR 0.049; 95% CI 0.006–0.420). Furthermore, the presence of distal HVs was correlated with the presence of LMCs. Conclusion: Distal HVs may be a marker for LMCs and act as a predictor of a favorable clinical outcome for patients with AIS.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Kamran S, Bates V, Bakshi R, Wright P, Kinkel W, Miletich R: Significance of hyperintense vessels on FLAIR MRI in acute stroke. Neurology 2000;55:265–269.
  2. Koga M, Kimura K, Minematusu K, Yamaguchi T: Hyperintense MCA branch sign on FLAIR-MRI. J Clin Neurosci 2002;9:187–189.

    External Resources

  3. Kawashima M, Noguchi T, Takase Y, Nakahara Y, Matsushima T: Decrease in leptomeningeal ivy sign on fluid-attenuated inversion recovery images after cerebral revascularization in patients with moyamoya disease. AJNR Am J Neuroradiol 2010;31:1713–1718.
  4. Sanossian N, Saver JL, Alger JR, Kim D, Duckwiler GR, Jahan R, Vinuela F, Ovbiagele B, Liebeskind DS: Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus. AJNR Am J Neuroradiol 2009;30:564–568.
  5. Azizyan A, Sanossian N, Mogensen MA, Liebeskind DS: Fluid-attenuated inversion recovery vascular hyperintensities: an important imaging marker for cerebrovascular disease. AJNR Am J Neuroradiol 2011;32:1771–1775.
  6. Liu W, Xu G, Yue X, et al: Hyperintense vessels on FLAIR: a useful non-invasive method for assessing intracerebral collaterals. Eur J Radiol 2010;80:786–791.

    External Resources

  7. Liu W, Yin Q, Yao L, Zhu S, Xu G, Zhang R, Ke K, Liu X: Decreased hyperintense vessels on FLAIR images after endovascular recanalization of symptomatic internal carotid artery occlusion. Eur J Radiol 2012;81:1595–1600.
  8. Kucinski T, Koch C, Eckert B, Becker V, Kromer H, Heesen C, Grzyska U, Freitag HJ, Rother J, Zeumer H: Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke. Neuroradiology 2003;45:11–18.
  9. Liebeskind DS: Collateral circulation. Stroke 2003;34:2279–2284.
  10. Lee KY, Latour LL, Luby M, Hsia AW, Merino JG, Warach S: Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke? Neurology 2009;72:1134–1139.
  11. Girot M, Gauvrit JY, Cordonnier C, Pruvo JP, Verdelho A, Leys D, Leclerc X: Prognostic value of hyperintense vessel signals on fluid-attenuated inversion recovery sequences in acute cerebral ischemia. Eur Neurol 2007;57:75–79.
  12. Schellinger PD, Chalela JA, Kang DW, Latour LL, Warach S: Diagnostic and prognostic value of early MR imaging vessel signs in hyperacute stroke patients imaged <3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 2005;26:618–624.
  13. Ebinger M, Kufner A, Galinovic I, Brunecker P, Malzahn U, Nolte CH, Endres M, Fiebach JB: Fluid-attenuated inversion recovery images and stroke outcome after thrombolysis. Stroke 2012;43:539–542.

    External Resources

  14. Krings T, Noelchen D, Mull M, Willmes K, Meister IG, Reinacher P, Toepper R, Thron AK: The hyperdense posterior cerebral artery sign: a computed tomography marker of acute ischemia in the posterior cerebral artery territory. Stroke 2006;37:399–403.
  15. Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP: Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2005;26:1789–1797.
  16. Liebeskind DS: Location, location, location: angiography discerns early MR imaging vessel signs due to proximal arterial occlusion and distal collateral flow. AJNR Am J Neuroradiol 2005;26:2432–2433.

    External Resources

  17. Sanossian N, Hao Q, Liebeskind DS: The thrombus and discontinuity of FLAIR vascular hyperintensity. Arch Neurol 2011;68:950–951.

    External Resources

  18. Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS: Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol 2011;10:909–921.
  19. Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, Lee KH, Liebeskind DS: Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011;42:693–699.
  20. Ribo M, Flores A, Rubiera M, Pagola J, Sargento-Freitas J, Rodriguez-Luna D, Coscojuela P, Maisterra O, Pineiro S, Romero FJ, Alvarez-Sabin J, Molina CA: Extending the time window for endovascular procedures according to collateral pial circulation. Stroke 2011;42:3465–3469.
  21. Hedera P, Bujdakova J, Traubner P, Pancak J: Stroke risk factors and development of collateral flow in carotid occlusive disease. Acta Neurol Scand 1998;98:182–186.
  22. Kim SJ, Ha YS, Ryoo S, Noh HJ, Ha SY, Bang OY, Kim GM, Chung CS, Lee KH: Sulcal effacement on fluid attenuation inversion recovery magnetic resonance imaging in hyperacute stroke: association with collateral flow and clinical outcomes. Stroke 2012;43:386–392.

    External Resources

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50