Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic StrokeHuang X.a, b · Liu W.a · Zhu W.a · Ni G.b · Sun W.c · Ma M.a · Zhou Z.b · Wang Q.d · Xu G.a · Liu X.a
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
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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.
© 2012 S. Karger AG, Basel
- 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.
- Koga M, Kimura K, Minematusu K, Yamaguchi T: Hyperintense MCA branch sign on FLAIR-MRI. J Clin Neurosci 2002;9:187–189.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Liebeskind DS: Collateral circulation. Stroke 2003;34:2279–2284.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.
- Sanossian N, Hao Q, Liebeskind DS: The thrombus and discontinuity of FLAIR vascular hyperintensity. Arch Neurol 2011;68:950–951.
- 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.
- 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.
- 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.
- 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.
- 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.
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