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Tokunaga K, Tokunaga S, Hara K, Yasaka M, Okada Y, Kitazono T, Tsumoto T. Fluid-attenuated inversion recovery vascular hyperintensity-diffusion-weighted imaging mismatch and functional outcome after endovascular reperfusion therapy for acute ischemic stroke. Interv Neuroradiol 2024; 30:189-194. [PMID: 35903941 PMCID: PMC11095359 DOI: 10.1177/15910199221113900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fluid-attenuated inversion recovery vascular hyperintensity (FVH) outside of the diffusion-weighted imaging (DWI) lesion, termed FVH-DWI mismatch, may represent penumbral tissue with good collateral status. METHODS Consecutive patients who underwent endovascular reperfusion therapy (EVT) for acute internal carotid artery (ICA) or middle cerebral artery (MCA)-M1 occlusion were enrolled. FVH-DWI mismatch score was defined as the number of cortical Alberta Stroke Program Early CT Score areas (I and M1 to M6) that involved FVH but no DWI lesion (0 to 7 points). The outcome measure was set as good functional outcome, defined as a modified Rankin Scale score of 0 to 2, at 90 days after onset. RESULTS Of 196 consecutive patients who underwent EVT for acute ICA or MCA-M1 occlusion, 32 without brain MRI before EVT were excluded, and the remaining 164 were analyzed. The median FVH-DWI mismatch score was 2 (interquartile range, 0 to 4). At 90 days after EVT, 2 patients were lost-to follow-up, and 73 had good functional outcome. The frequency of good functional outcome at 90 days after EVT increased significantly with increasing FVH-DWI mismatch score (P for trend <0.001). FVH-DWI mismatch score was independently associated with good functional outcome at 90 days after onset (adjusted odds ratio per 1 point,1.46; 95% confidence interval, 1.15-1.89). CONCLUSIONS Patients with large FVH-DWI mismatch had good functional outcome after EVT for acute ICA or MCA-M1 occlusion.
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Affiliation(s)
- Keisuke Tokunaga
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - So Tokunaga
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kenta Hara
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Tsumoto
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Lv B, Ran Y, Lv J, Lou X, Tian C. Individualized interpretation for the clinical significance of fluid-attenuated inversion recovery vessel hyperintensity in ischemic stroke and transient ischemic attack: A systematic narrative review. Eur J Radiol 2023; 166:111010. [PMID: 37523872 DOI: 10.1016/j.ejrad.2023.111010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
Fluid-attenuated inversion recovery (FLAIR) vessel hyperintensity(FVH)refers to the hyperintensity corresponding to the arteries in the subarachnoid space. It is caused by critically slowed blood flow and is commonly encountered in patients with large artery steno-occlusions. Quite a few studies have focused on the clinical significance of FLAIR vessel hyperintensity in terms of its relationship to the prognosis of transient ischemic attack (TIA), baseline severity or infarction volume, early neurological deterioration or infarction growth, and functional outcomes in acute ischemic stroke (AIS). However, inconsistent or conflicting findings were common in these studies and caused confusion in the clinical decision-making process guided by this imaging marker. Through reviewing the available studies on the etiologic mechanism of FVH and investigating findings on its clinical significance in AIS and TIA, this review aims to elucidate the key factors for interpreting the clinical significance of FVH individually.
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Affiliation(s)
- Bin Lv
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Ye Ran
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Jinhao Lv
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Xin Lou
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China.
| | - Chenglin Tian
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China.
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3
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Prognostic value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity in ischemic stroke after endovascular thrombectomy. Eur Radiol 2022; 32:8067-8076. [PMID: 35665844 DOI: 10.1007/s00330-022-08886-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/10/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To explore the value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity (FVH) in predicting clinical outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). METHODS This retrospective study reviewed data from consecutive patients with large vessel occlusion of anterior circulation between July 2017 and February 2021. Together with other variables, status of post-treatment FVH was assessed for each patient. Good outcome was defined as a 3-month modified Rankin Scale score of 0-2. Chi-square test, Fisher's exact test, independent-samples t test, multivariate logistic regression analysis, and receiver operating characteristic analysis were used as appropriate. RESULTS Among 84 included patients, 48 (57.1%) patients showed post-treatment FVH. Post-treatment FVH significantly correlated with incomplete recanalization (p < 0.05) and low Alberta Stroke Project Early CT Changes Score on post-treatment diffusion-weighted imaging (p < 0.05). Higher incidence of hemorrhage transformation was observed in patients with post-treatment FVH than those without (27.1% vs. 16.7%); however, the difference did not reach significance (p = 0.259). Successful recanalization (odds ratio [OR], 0.024; 95% confidence interval [CI] 0.003-0.194; p < 0.05), lower National Institutes of Health Stroke Scale scores at admission (NIHSSpre) (OR, 1.196; 95% CI, 1.017-1.406; p < 0.05), and no post-treatment FVH (OR, 74.690; 95% CI, 4.624-1206.421; p < 0.05) were found to be independent predictors of good outcomes. Combined models integrating all three independent predictors (recanalization+NIHSSpre+post-treatment FVH) significantly outperformed the combined model without post-treatment FVH (recanalization+NIHSSpre) in predicting clinical outcome (p = 0.004). CONCLUSIONS Post-treatment FVH may be an effective prognostic marker associated with clinical outcome in patients with AIS after EVT. KEY POINTS • Post-treatment FVH correlates with incomplete recanalization and higher infarct volume. • Post-treatment FVH is independently associated with an unfavorable outcome. • Post-treatment FVH may provide prognostic information in patients with AIS after EVT.
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Lyu JH, Zhang SH, Wang XY, Meng ZH, Wu XY, Chen W, Wang GH, Niu QL, Li X, Bian YT, Han D, Guo WT, Yang S, Wei MT, Zhang TY, Duan Q, Duan CH, Bian XB, Tian CL, Lou X. FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy. Eur Radiol 2022; 32:5436-5445. [DOI: 10.1007/s00330-022-08661-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/13/2022]
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5
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Zeng L, Chen J, Liao H, Wang Q, Xie M, Wu W. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians. Front Aging Neurosci 2022; 13:790626. [PMID: 34975459 PMCID: PMC8716740 DOI: 10.3389/fnagi.2021.790626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.
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Affiliation(s)
- Lichuan Zeng
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinxin Chen
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaqiang Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qu Wang
- Department of Ultrasound, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenbin Wu
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Faust O, En Wei Koh J, Jahmunah V, Sabut S, Ciaccio EJ, Majid A, Ali A, Lip GYH, Acharya UR. Fusion of Higher Order Spectra and Texture Extraction Methods for Automated Stroke Severity Classification with MRI Images. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8059. [PMID: 34360349 PMCID: PMC8345794 DOI: 10.3390/ijerph18158059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
This paper presents a scientific foundation for automated stroke severity classification. We have constructed and assessed a system which extracts diagnostically relevant information from Magnetic Resonance Imaging (MRI) images. The design was based on 267 images that show the brain from individual subjects after stroke. They were labeled as either Lacunar Syndrome (LACS), Partial Anterior Circulation Syndrome (PACS), or Total Anterior Circulation Stroke (TACS). The labels indicate different physiological processes which manifest themselves in distinct image texture. The processing system was tasked with extracting texture information that could be used to classify a brain MRI image from a stroke survivor into either LACS, PACS, or TACS. We analyzed 6475 features that were obtained with Gray-Level Run Length Matrix (GLRLM), Higher Order Spectra (HOS), as well as a combination of Discrete Wavelet Transform (DWT) and Gray-Level Co-occurrence Matrix (GLCM) methods. The resulting features were ranked based on the p-value extracted with the Analysis Of Variance (ANOVA) algorithm. The ranked features were used to train and test four types of Support Vector Machine (SVM) classification algorithms according to the rules of 10-fold cross-validation. We found that SVM with Radial Basis Function (RBF) kernel achieves: Accuracy (ACC) = 93.62%, Specificity (SPE) = 95.91%, Sensitivity (SEN) = 92.44%, and Dice-score = 0.95. These results indicate that computer aided stroke severity diagnosis support is possible. Such systems might lead to progress in stroke diagnosis by enabling healthcare professionals to improve diagnosis and management of stroke patients with the same resources.
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Affiliation(s)
- Oliver Faust
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Joel En Wei Koh
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Vicnesh Jahmunah
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Sukant Sabut
- School of Electronics Engineering, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha 751024, India;
| | - Edward J. Ciaccio
- Department of Medicine-Cardiology, Columbia University, New York, NY 10027, USA;
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK;
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Sheffield S10 2JF, UK;
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 7TX, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - U. Rajendra Acharya
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, Singapore 599494, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 860-8555, Japan
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Shin DH, Han SK, Lee JH, Choi PC, Park SO, Lee YH, Ung Na J. Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study. Acta Radiol 2021; 62:922-931. [PMID: 32762244 DOI: 10.1177/0284185120946718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries. PURPOSE To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA). MATERIAL AND METHODS The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively. RESULTS The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781-121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis. CONCLUSION A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.
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Affiliation(s)
- Dong Hyuk Shin
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Kuk Han
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jang Hee Lee
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pil Cho Choi
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ji Ung Na
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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8
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Jing L, Sui B, Shen M, Qin H, Ke D, Gao P. Comparison of three FLAIR vascular hyperintensities methodologies in patients with acute ischemic stroke. Acta Radiol 2021; 62:766-775. [PMID: 32660319 DOI: 10.1177/0284185120939271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple methods have been used to analyze fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) which may represent collaterals in patients with acute ischemic stroke (AIS); however, there is no consensus between methods. PURPOSE To compare three frequently used FVH methods for predicting early infarct volume and clinical outcome in patients with AIS. MATERIAL AND METHODS Patients with AIS in middle cerebral artery territory were recruited. FVHs were evaluated using extensive FVHs, FVH-diffusion-weighted imaging (DWI) mismatch, and FVH-in/out-DWI. Infarct volume at baseline and day 7 were measured. Early neurological improvement (ENI) was assessed. Good outcomes were defined by modified Rankin Scale scores of 0-2 at 90 days. RESULTS Fifty-one patients were included. ENI was 55.6% in patients with extensive FVHs and 23.3% in those without (P = 0.024). Patients with extensive FVHs had smaller infarct volume growth at seven days than those without (P = 0.041). ENI was 48.3% in patients with FVH-DWI mismatch and 15.8% in those without (P = 0.021). Patients with FVH-DWI mismatch had smaller infarct volumes at seven days than those without (P = 0.038). Patients with FVH-out-DWI had smaller baseline infarct volumes, smaller seven-day volumes, and smaller infarct growth than those with FVH-in-DWI (P<0.001, P<0.001, and P = 0.031, respectively). In multivariate logistic regression analysis, the infarct growth at seven days negatively independently predicted ENI (OR = 0.737, 95% CI 0.593-0.915, P = 0.006). However, none of the FVH classifications could predict a good 90-day outcome. CONCLUSION Patients with extensive FVHs or FVH-DWI mismatch tend to have early favorable clinical outcome. FVH-out-DWI being associated with smaller infarct growth may also indicate early favorable clinical outcome.
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Affiliation(s)
- Lina Jing
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Dena Ke
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
- Beijing Neurosurgical Institute, Beijing, PR China
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9
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Grosch AS, Kufner A, Boutitie F, Cheng B, Ebinger M, Endres M, Fiebach JB, Fiehler J, Königsberg A, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Siemonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Galinovic I. Extent of FLAIR Hyperintense Vessels May Modify Treatment Effect of Thrombolysis: A Post hoc Analysis of the WAKE-UP Trial. Front Neurol 2021; 11:623881. [PMID: 33613422 PMCID: PMC7890254 DOI: 10.3389/fneur.2020.623881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Fluid-attenuated inversion recovery (FLAIR) hyperintense vessels (FHVs) on MRI are a radiological marker of vessel occlusion and indirect sign of collateral circulation. However, the clinical relevance is uncertain. We explored whether the extent of FHVs is associated with outcome and how FHVs modify treatment effect of thrombolysis in a subgroup of patients with confirmed unilateral vessel occlusion from the randomized controlled WAKE-UP trial. Methods: One hundred sixty-five patients were analyzed. Two blinded raters independently assessed the presence and extent of FHVs (defined as the number of slices with visible FHV multiplied by FLAIR slice thickness). Patients were then separated into two groups to distinguish between few and extensive FHVs (dichotomization at the median <30 or ≥30). Results: Here, 85% of all patients (n = 140) and 95% of middle cerebral artery (MCA) occlusion patients (n = 127) showed FHVs at baseline. Between MCA occlusion patients with few and extensive FHVs, no differences were identified in relative lesion growth (p = 0.971) and short-term [follow-up National Institutes of Health Stroke Scale (NIHSS) score; p = 0.342] or long-term functional recovery [modified Rankin Scale (mRS) <2 at 90 days poststroke; p = 0.607]. In linear regression analysis, baseline extent of FHV (defined as a continuous variable) was highly associated with volume of hypoperfused tissue (β = 2.161; 95% CI 0.96–3.36; p = 0.001). In multivariable regression analysis adjusted for treatment group, stroke severity, lesion volume, occlusion site, and recanalization, FHV did not modify functional recovery. However, in patients with few FHVs, the odds for good functional outcome (mRS) were increased in recombinant tissue plasminogen activator (rtPA) patients compared to those who received placebo [odds ratio (OR) = 5.3; 95% CI 1.2–24.0], whereas no apparent benefit was observed in patients with extensive FHVs (OR = 1.1; 95% CI 0.3–3.8), p-value for interaction was 0.11. Conclusion: While the extent of FHVs on baseline did not alter the evolution of stroke in terms of lesion progression or functional recovery, it may modify treatment effect and should therefore be considered relevant additional information in those patients who are eligible for intravenous thrombolysis. Clinical Trial Registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered February 2, 2012.
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Affiliation(s)
- Anne Sophie Grosch
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Kufner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Bastian Cheng
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Excellence Cluster NeuroCure, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Königsberg
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain & Disease Research, Flanders Institute for Biotechnology, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Claude Bernard University Lyon 1, CREATIS National Center for Scientific Research Mixed Unit of Research 5220-National Institute of Health and Medical Research U1206, National Institute of Applied Sciences of Lyon, Lyon Civil Hospices, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Girona Institute of Biomedical Research, Institute of Diagnostic Imaging, Dr. Josep Trueta Hospital, Girona, Spain
| | - Claus Z Siemonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain & Disease Research, Flanders Institute for Biotechnology, Leuven, Belgium
| | - Christian Gerloff
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke. J Neuroradiol 2021; 49:258-266. [PMID: 33515596 DOI: 10.1016/j.neurad.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023]
Abstract
Fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) is a common presentation on brain magnetic resonance images of patients with acute ischemic stroke. This sign is known as a sluggish collateral flow. Although FVH represents the large ischemic penumbra and collateral circulation, the clinical significance of FVH has not been established. Varying protocols for FLAIR, treatment differences, and heterogeneity of endpoints across studies have complicated the interpretation of FVH in patients with acute stroke. In this review article, we describe the mechanism of FVH, as well as its association with functional outcome, perfusion-weighted images, and large artery stenosis. In addition, we review the technological variables that affect FVH and discuss the future perspectives.
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Kashiwazaki D, Yamamoto S, Akioka N, Hori E, Shibata T, Kuwayama N, Noguchi K, Kuroda S. High-intensity vessel sign on fluid-attenuated inversion recovery imaging: a novel imaging marker of high-risk carotid stenosis-a MRI and SPECT study. Acta Neurochir (Wien) 2020; 162:2573-2581. [PMID: 32458404 DOI: 10.1007/s00701-020-04408-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measurement of luminal stenosis and determination of plaque instability using MR plaque imaging are effective strategies for evaluating high-risk carotid stenosis. Nevertheless, new methods are required to identify patients with carotid stenosis at risk of future stroke. We aimed to clarify the mechanisms and clinical implications of the hyperintense vessel sign (HVS) as a marker of high-risk carotid stenosis. METHODS We included 148 patients who underwent carotid stent (CAS) or carotid endarterectomy (CEA). MRI FLAIR was performed to detect HVS prior to and within 7 days after CAS/CEA. MR plaque imaging and 123I-iodoamphetamine SPECT was performed prior to CEA/CAS. Detailed characteristics of HVS were categorized in terms of symptomatic status, hemodynamic state, plaque composition, and HVS on time series. RESULTS Forty-six of 80 symptomatic hemispheres (57.5%) and 5 of 68 asymptomatic hemispheres (7.4%) presented HVS (P < 0.01). Of the 46 symptomatic hemispheres with HVS, 19 (41.3%) presented with hemodynamic impairment and 27 (58.7%) presented without hemodynamic impairment. Of 19 hemispheres with hemodynamic impairment, 12 subjects (63.2%) showed high intensity and 7 (36.8%) showed iso-intensity plaques on T1WI. All 27 hemispheres without hemodynamic impairment showed high-intensity plaques. Of the five asymptomatic and HVS-positive hemispheres, one showed hemodynamic impairment; MR plaque imaging revealed T1 iso-intensity. The other four hemispheres that did not show hemodynamic impairment showed T1WI high-intensity plaques. CONCLUSION There are two possible mechanisms of HVS, hemodynamic impairment due to severe carotid stenosis and micro-embolism from unstable plaques. HVS could be a radiological marker for high-risk carotid stenosis.
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Affiliation(s)
- Daina Kashiwazaki
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Shusuke Yamamoto
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoki Akioka
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Emiko Hori
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takashi Shibata
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoya Kuwayama
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kyo Noguchi
- Department of Radiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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The impact of FLAIR vascular hyperintensity on clinical severity and outcome : A retrospective study in stroke patients with proximal middle cerebral artery stenosis or occlusion. Neurol Sci 2020; 42:589-598. [PMID: 32643132 DOI: 10.1007/s10072-020-04513-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The clinical significance of fluid-attenuated inversion recovery vascular hyperintensity (FVH) has not been clarified. The aim of this study was to clarify the effects of FVH on the clinical severity and long-term prognosis of patients with proximal middle cerebral artery (MCA) occlusion or severe stenosis. METHOD Because their clinical and imaging data is not accessible, we excluded the patients being treated with IV thrombolysis or mechanical thrombectomy. Clinical and imaging characteristics were documented in 282 consecutive AIS patients with proximal MCA occlusion or severe stenosis. We assessed clinical severity using the National Institutes of Health Stroke Scale (NIHSS) score and clinical outcomes using mRS scores. The average time interval between symptom onset and imaging was 16-18 h. The FVH score according to FVH-ASPECTS ranged from 0 to 7, based on the numbers of territories where FVH is positive. RESULTS FVH was observed in 235 (83.33%) of the AIS patients. The FVH(+) group tended to have more alcoholics (65 [27.66%] vs 6 [12.77%], P = 0.032), a higher NIHSS score on the 7th day (3 [1-6] vs 2 [1-3], P = 0.039), more instances of early neurological deterioration (END) (27 [11.4%] vs 1 [2.12%], P = 0.05), and more patients with MCA occlusion (94 [40.00%] vs 3 [6.38%]). Among the patients with positive FVH, a high FVH score represented severe clinical impairment (higher NIHSS score on admission [P = 0.009] and 7th day since admission [P = 0.02]) and poor clinical outcomes. Spearman's rank correlations showed that FVH scores were positively correlated with NIHSS scores on admission and NIHSS scores on the 7th day (P = 0.039; P = 0.017, respectively). CONCLUSION In patients with proximal middle cerebral artery (MCA) occlusion or stenosis ≥ 70%, a high FVH score represented severe clinical impairment and poor clinical outcomes. In acute ischemic stroke (AIS) patients with proximal MCA occlusion, a high FVH score represented favorable clinical outcomes.
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13
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Zhou Z, Malavera A, Yoshimura S, Delcourt C, Mair G, Al-Shahi Salman R, Demchuk AM, Wardlaw JM, Lindley RI, Anderson CS. Clinical prognosis of FLAIR hyperintense arteries in ischaemic stroke patients: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2020; 91:475-482. [PMID: 32217786 DOI: 10.1136/jnnp-2019-322625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to determine the association of fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on brain MRI and prognosis after acute ischaemic stroke (AIS). METHODS We searched Medline, Embase and Cochrane Central Register of Controlled Trials for studies reporting clinical or imaging outcomes with presence of FLAIR-HAs after AIS. Two researchers independently assessed eligibility of retrieved studies and extracted data, including from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Outcomes were unfavourable functional outcome (primary, modified Rankin scale scores 3-6 or 2-6), death, intermediate clinical and imaging outcomes. We performed subgroup analyses by treatment or types of FLAIR-HAs defined by location (at proximal/distal middle cerebral artery (MCA), within/beyond diffusion-weighted imaging (DWI) lesion) or extent. RESULTS We included 36 cohort studies (33 prospectively collected) involving 3577 patients. FLAIR-HAs were not associated with functional outcome overall (pooled risk ratio 0.87, 95% CI 0.71 to 1.06), but were significantly associated with better outcome in those receiving endovascular therapy (0.56, 95% CI 0.41 to 0.75). Contrary to FLAIR-HAs at proximal MCA or within DWI lesions, FLAIR-HAs beyond DWI lesions were associated with better outcome (0.67, 95% CI 0.57 to 0.79). FLAIR-HAs favoured recanalisation (1.21, 95% CI 1.06 to 1.38) with increased risk of intracerebral haemorrhage (2.07, 95% CI 1.37 to 3.13) and early neurological deterioration (1.93, 95% CI 1.30 to 2.85). CONCLUSIONS FLAIR-HAs were not associated with functional outcome overall but were associated with outcome after endovascular therapy for AIS. FLAIR-HAs were also associated with early recanalisation or haemorrhagic complications, and early neurologic deterioration. PROSPERO REGISTRATION NUMBER CRD42019131168.
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Affiliation(s)
- Zien Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China .,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alejandra Malavera
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sohei Yoshimura
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Candice Delcourt
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Grant Mair
- Division of Neuroimaging Science, Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Andrew M Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanna M Wardlaw
- Division of Neuroimaging Science, Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard I Lindley
- The George Institute for Global Health and University of Sydney, Sydney, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Center, Beijing, PR China
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14
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Nomura T, Okamoto K, Igarashi H, Watanabe M, Hasegawa H, Oishi M, Fujii Y. Vascular Hyperintensity on Fluid-Attenuated Inversion Recovery Indicates the Severity of Hypoperfusion in Acute Stroke. J Stroke Cerebrovasc Dis 2019; 29:104467. [PMID: 31767525 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/29/2019] [Accepted: 10/07/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM Although fluid-attenuated inversion recovery vascular hyperintensities may be frequently seen in acute large-artery ischemic stroke, reports on their prognostic utility had been conflicting due to lack of quantitative evaluation of the perfusion status based on the signal intensity. We hypothesized that greater hyperintensity represents more severe hypoperfusion. METHODS Overall, 27 patients with acute occlusion of the proximal middle cerebral artery were divided into 2 groups, based on their signal intensity in the insular segment of middle cerebral artery on the affected side, relative to that of the insular cortex: the low signal intensity group (hypo- or isointense signals, n = 12) and the high signal intensity group (hyperintense signals, n = 15). Using dynamic susceptibility contrast magnetic resonance imaging, we assessed the time of the maximum value of the residue function and mean transit time, in the entire middle cerebral artery cortical area and diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, including the corona radiata. RESULTS The high signal intensity group had significantly longer time of the maximum value of the residue function in all the diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, except the M3 and M6 regions, and significantly longer mean transit time in the M1 and M4 regions. CONCLUSIONS Quantitative analysis of the perfusion parameters revealed more severely compromised and widely disturbed perfusion status in the high signal intensity group than in the low signal intensity group.
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Affiliation(s)
- Toshiharu Nomura
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan; Center for Integrated Brain Science, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Translational Research, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan
| | - Hironaka Igarashi
- Center for Integrated Brain Science, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan
| | - Masato Watanabe
- Department of Neurosurgery, Kuwana Hospital,Higashi-ku, Niigata, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Chuo-ku, Niigata, Japan.
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15
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Topography of the hyperintense vessel sign on fluid-attenuated inversion recovery represents cerebral hemodynamics in middle cerebral artery occlusion: a CT perfusion study. Neuroradiology 2019; 61:1123-1130. [PMID: 31154469 DOI: 10.1007/s00234-019-02231-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Whether the topography of fluid-attenuated inversion recovery hyperintense vessel sign (FHVs) can serve as a measure of cerebral hemodynamic stress remains unclear. We hypothesized that FHVs topography represents different cerebral hemodynamic status, as assessed by CT perfusion (CTP). METHODS We retrospectively reviewed 75 patients with acute middle cerebral artery (MCA) occlusion who underwent MR imaging and CTP. The FHVs topography included FHVs inside the diffusion-weighted imaging (DWI) lesion (FHVs in-group), FHVs outside the DWI lesion (FHVs out-group), and FHVs distributed inside and outside the DWI lesion (FHVs all-group). FHVs scores were assessed by the Alberta stroke program early computed tomography score (ASPECT) territories. Cerebral hemodynamic status was evaluated by relative (r) CTP parameters. Cerebral hemodynamic status was analyzed with respect to different FHVs topographies and FHVs scores. RESULTS Hemodynamic impairment was present in all patients, with the following mean rCTP parameters: rCBF, 0.77 ± 0.23; rCBV, 1.06 ± 0.32; and rMTT, 1.52 ± 0.60. Comparison of the rCTP parameters among the three groups, rCBF and rCBV (rCBF, P < 0.001; rCBV, P < 0.001) in the FHVs out-group and the FHVs all-group (rCBF, P = 0.001; rCBV, P < 0.001), were significantly higher than that in the FHVs in-group. Similarly, CTA collateral grade in the FHVs in-group was significantly lower than those in the FHVs out-group and FHVs all-group (P < 0.001). No significant difference was found in rCTP parameters between different FHVs scores. CONCLUSION The different FHVs topographies represented different cerebral hemodynamic status. FHVs topography may serve as a surrogate for patient selection for reperfusion therapy whenever perfusion data are unavailable.
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16
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Shang WJ, Chen HB, Shu LM, Liao HQ, Huang XY, Xiao S, Hong H. The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset. AJNR Am J Neuroradiol 2019; 40:1317-1322. [PMID: 31371355 DOI: 10.3174/ajnr.a6142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensity has been recognized as a marker of collaterals in ischemic stroke, but the impact on outcome is still controversial. We hypothesized that the association between FLAIR vascular hyperintensity and outcome varies with time. MATERIALS AND METHODS We included 459 consecutive patients with middle cerebral artery stroke and divided them into 3 groups by symptom-to-MR imaging time (group 1, ≤7 days; group 2, 8-14 days; group 3, ≥15 days). The FLAIR vascular hyperintensity score, ranging from 0 to 3 points, was based on territory distributions of different MCA segments. The associations between FLAIR vascular hyperintensity and outcome with time were analyzed qualitatively and quantitatively. RESULTS No patients underwent MR imaging within 6 hours of onset. The proportion of FLAIR vascular hyperintensity (+) and severe stenosis or occlusion of MCA was not significantly dependent on time. In groups 1 and 2, FLAIR vascular hyperintensity (+) was significantly associated with larger lesions, the prevalence of flow injury, and unfavorable outcome (mRS ≥ 2). There were no such associations in group 3. Multiple logistic regressions demonstrated that FLAIR vascular hyperintensity (+) was an independent risk factor for unfavorable outcome in group 2. Infarction volume tended to increase with the increase of the distal FLAIR vascular hyperintensity score in groups 1 and 2, while declining in group 3. CONCLUSIONS FLAIR vascular hyperintensity is associated with unfavorable outcome within 6 hours to 14 days of onset, while the wider distribution of distal FLAIR vascular hyperintensity may be favorable beyond 14 days of onset in MCA infarction. Symptom-to-MR imaging time should be considered when assessing the prognostic value of FLAIR vascular hyperintensity.
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Affiliation(s)
- W J Shang
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - H B Chen
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - L M Shu
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - H Q Liao
- Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - X Y Huang
- Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - S Xiao
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - H Hong
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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17
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FLAIR hyperintensities-DWI mismatch in acute stroke: associations with DWI volume and functional outcome. Brain Imaging Behav 2019; 14:1230-1237. [DOI: 10.1007/s11682-019-00156-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Fluid-attenuated inversion recovery vascular hyperintensities in anterior circulation acute ischemic stroke: associations with cortical brain infarct volume and 90-day prognosis. Neurol Sci 2019; 40:1675-1682. [PMID: 31037507 DOI: 10.1007/s10072-019-03909-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is often observed in conjunction with acute ischemic stroke (AIS) of the carotid system. However, the significance of FVH in patients with AIS has not been fully elucidated. The purpose of this study is to investigate the effects of FVH on the final infarct volume (including cortical and deep brain infarct volume) and on 90-day prognosis in AIS patients. MATERIAL AND METHODS We analyzed data of 160 patients who had AIS of anterior circulation. FVH was identified and the cortical brain infarct volume (CBIV) and deep brain infarct volume (DBIV) were calculated. We assessed 90-day clinical outcome using the modified Rankin Scale (mRS). RESULTS FVH was identified in 83 of the 160 patients (51.88%). Patients with FVH showed larger CBIV (13.94 ± 25.55 vs. 6.56 ± 13.49 ml; p = 0.025), more frequent intracranial-large artery disease (74.70 vs. 27.27%; p < 0.001), and more severe clinical impairment on admission (NIHSS 7.22 ± 4.01 vs. 5.42 ± 4.52; p = 0.009). Considering the factors influencing prognosis, FVH positivity (OR = 2.12, 95% CI 1.13-3.99; p = 0.02) and NIHSS (at discharge) (OR = 2.14, 95% CI 1.64-2.78; p < 0.001) were independently associated with 90-day clinical outcome of AIS patients. CONCLUSION FVH is a more common finding associated with larger CBIV, intracranial-large artery disease, and more severe strokes on admission. In the presence of good collateral circulation, FVH may be a predictor of better outcome in anterior circulation AIS patients at 90 days.
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Legrand L, Turc G, Edjlali M, Beaumont M, Gautheron V, Ben Hassen W, Charron S, Trystram D, Boulouis G, Bourcier R, Benzakoun J, Naggara O, Clarençon F, Bracard S, Oppenheim C. Benefit from revascularization after thrombectomy according to FLAIR vascular hyperintensities–DWI mismatch. Eur Radiol 2019; 29:5567-5576. [DOI: 10.1007/s00330-019-06094-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022]
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Xu J, Chen X, Lin M. Significance of Magnetic Resonance Imaging (MRI) T2 Hyperintense Endo-Vessels Sign in Progressive Posterior Circulation Infarction. Med Sci Monit 2018; 24:3873-3881. [PMID: 29882523 PMCID: PMC6022782 DOI: 10.12659/msm.908300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background MRI FLAIR hyperintense vessels sign (FHVs) is a special imaging marker that plays a key role in acute infarction imaging and diagnosis. However, FHVs have not been studied in the context of progressive posterior circulation infarction (PPCI), and little is known about the association of hyperintense endo-vessels sign (HEVs) on transverse section MRI with infarction. Thus, our objective here was to investigate the clinical significance of transverse MRI T2 HEVs in patients with PPCI. Material/Methods In this retrospective, case-control study, we enrolled 100 consecutive posterior circulation infarction patients. All the patients underwent head MRI examinations on the onset day and the seventh day after admission. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) scores upon admission and after 7 days. Infarction volume on DWI was compared. Results HEVs were detected in 25 of 37 patients in the PPCI group (67.6%) and 22 of 63 patients in the NPPCI group (34.9%). Logistic regression analysis showed that the proportion of HEVs in the PPCI group was higher than in the NPPCI group (P=0.007). Among all the patients, HEVs were detected in 15 of 18 patients (83.3%) with occlusion of the vertebral artery or basilar artery, and 17 of 23 (73.9%) showed severe stenosis. The proportion of vertebrobasilar artery occlusions in the PPCI group was higher than in the NPPCI group (P<0.05). MRI DWI showed that 20 patients had cerebellum infarction among 23 vertebral artery HEVs patients, and 14 patients had brainstem infarction among 15 basilar artery HEVs patients. All of the 9 vertebral and basilar artery HEVs patients had brainstem infarction. The increase in NIHSS scores from baseline to 7 days was significantly greater in patients with HEVs than in patients without HEVs in the PPCI group (P=0.002). The expansion of the infarction size from baseline to 7 days was significantly larger in patients with HEVs than in patients without HEVs in the PPCI group (P=0.037). Conclusions HEVs are frequently detected in patients with vertebrobasilar artery territory infarction, and they can be considered as a special imaging marker for vertebral artery and basilar artery occlusion and severe stenosis. HEVs can indicate whether or not posterior circulation infarction progresses and they may be an independent risk factor of PPCI.
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Affiliation(s)
- Jialiang Xu
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Xiaohong Chen
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Muhui Lin
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
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Mahdjoub E, Turc G, Legrand L, Benzakoun J, Edjlali M, Seners P, Charron S, Ben Hassen W, Naggara O, Meder JF, Mas JL, Baron JC, Oppenheim C. Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy? AJNR Am J Neuroradiol 2017; 39:77-83. [PMID: 29074634 DOI: 10.3174/ajnr.a5431] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio. MATERIALS AND METHODS We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio. RESULTS Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19-0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3-5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; P for Trend = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002). CONCLUSIONS In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.
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Affiliation(s)
- E Mahdjoub
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - G Turc
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - L Legrand
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J Benzakoun
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - M Edjlali
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - P Seners
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - S Charron
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - W Ben Hassen
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - O Naggara
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J-F Meder
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J-L Mas
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - J-C Baron
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - C Oppenheim
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
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22
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Nam KW, Kwon HM, Park SW, Lim JS, Han MK, Lee YS. Distal hyperintense vessel sign is associated with neurological deterioration in acute ischaemic stroke. Eur J Neurol 2017; 24:617-623. [DOI: 10.1111/ene.13259] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- K.-W. Nam
- Department of Neurology; Seoul Metropolitan Government − Seoul National University Boramae Medical Center; Seoul Korea
| | - H.-M. Kwon
- Department of Neurology; Seoul Metropolitan Government − Seoul National University Boramae Medical Center; Seoul Korea
- Department of Neurology; College of Medicine; Seoul National University; Seoul Korea
| | - S.-W. Park
- Department of Radiology; Seoul Metropolitan Government − Seoul National University Boramae Medical Center; Seoul Korea
- Department of Radiology; College of Medicine; Seoul National University; Seoul Korea
| | - J.-S. Lim
- Department of Neurology; Hallym University Sacred Heart Hospital; Anyang Korea
| | - M.-K. Han
- Department of Neurology; Seoul National University Bundang Hospital; Seongnam Korea
| | - Y.-S. Lee
- Department of Neurology; Seoul Metropolitan Government − Seoul National University Boramae Medical Center; Seoul Korea
- Department of Neurology; College of Medicine; Seoul National University; Seoul Korea
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23
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Liu D, Scalzo F, Rao NM, Hinman JD, Kim D, Ali LK, Saver JL, Sun W, Dai Q, Liu X, Liebeskind DS. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity Topography, Novel Imaging Marker for Revascularization in Middle Cerebral Artery Occlusion. Stroke 2016; 47:2763-2769. [PMID: 27659851 DOI: 10.1161/strokeaha.116.013953] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In acute arterial occlusion, fluid-attenuated inversion recovery vascular hyperintensity (FVH) has been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH topography or FVH-Alberta Stroke Program Early CT Score (ASPECTS) pattern and outcome in acute M1-middle cerebral artery occlusion patients with endovascular treatment. METHODS We included acute M1-middle cerebral artery occlusion patients treated with endovascular therapy (ET). All patients had diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery before ET. Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. The presence of FVH inside and outside DWI-positive lesions was separately analyzed. Clinical outcome after ET was analyzed with respect to different distal FVH-ASPECTS topography. RESULTS Among 101 patients who met inclusion criteria for the study, mean age was 66.2±17.8 years and median National Institutes of Health Stroke Scale was 17.0 (interquartile range, 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (modified Rankin Scale [mRS] score of 0-2; 8.0 versus 4.0, P<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (odds ratio, 1.3; 95% confidence interval, 1.06-1.68; P=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhagic transformation (odds ratio, 1.3; 95% confidence interval, 1.04-1.51; P=0.019). CONCLUSIONS Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing ET. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhagic transformation. The FVH pattern, not number, can serve as an imaging selection marker for ET in acute middle cerebral artery occlusion.
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Affiliation(s)
- Dezhi Liu
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Fabien Scalzo
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Neal M Rao
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Jason D Hinman
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Doojin Kim
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Latisha K Ali
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Jeffrey L Saver
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Wen Sun
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Qiliang Dai
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Xinfeng Liu
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - David S Liebeskind
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
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24
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Leng X, Lan L, Liu L, Leung TW, Wong KS. Good collateral circulation predicts favorable outcomes in intravenous thrombolysis: a systematic review and meta-analysis. Eur J Neurol 2016; 23:1738-1749. [PMID: 27478977 DOI: 10.1111/ene.13111] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Baseline collateral status has been correlated with outcomes of acute ischaemic stroke patients receiving intravenous thrombolysis (IVT) in previous studies. We carried out the current systematic review and meta-analysis to synthesize currently available evidence regarding such correlations. METHODS Full-text articles published since 2000 were retrieved and screened. The overall effect sizes of good versus poor collateral status over a series of outcomes and certain baseline features were estimated by random-effects models and presented in risk ratios (RRs) or mean differences. RESULTS Overall, 28 (3057 patients) and 14 (1584 patients) studies were included in qualitative and quantitative synthesis, respectively. Compared with poor pre-treatment collateral status, good collaterals showed a beneficial effect over the primary outcome of a favorable functional outcome at 3 or 6 months [RR, 2.45; 95% confidence interval, 1.94-3.09; P < 0.001] in acute ischaemic stroke patients receiving IVT treatment. However, such an effect tended to be different between studies with prescribed time windows of 3, 4.5 and > 4.5 h (up to 7 h), with the RRs being 2.21, 2.48 and 5.00, respectively (I2 = 53%). Good pre-treatment collaterals were also associated with a smaller infarct size at baseline, and a lower rate of symptomatic intracranial hemorrhage and a higher rate of neurological improvement early after IVT treatment. CONCLUSIONS The present study has demonstrated the prognostic value of baseline collateral circulation for outcomes of acute ischaemic stroke patients receiving intravenous reperfusion therapies, studied with different time windows of up to 7 h after ictus for IVT therapy.
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Affiliation(s)
- X Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - L Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - L Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - T W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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25
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Vural A, Gocmen R, Oguz KK, Topcuoglu MA, Arsava EM. Bright and dark vessels on stroke imaging: different sides of the same coin? Diagn Interv Radiol 2016; 22:284-90. [PMID: 27015319 DOI: 10.5152/dir.2015.15271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Prominent hypointense cerebral vessels on susceptibility-weighted imaging (SWI) and the hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) imaging are considered as markers of compromised tissue perfusion in cerebral ischemia. In this study, we aimed to identify the correlation between HVS on FLAIR and hypointense vessels on SWI, and to determine whether these imaging features provide independent prognostic information in patients with ischemic stroke. METHODS We retrospectively analyzed consecutive ischemic stroke patients with proximal middle cerebral artery (MCA) occlusion who underwent SWI and FLAIR within 24 h of symptom onset. The presence of hypointense vessels on SWI and hyperintense vessels on FLAIR in >4 of 10 slices encompassing the MCA territory were considered to represent prominent hypoperfusion. RESULTS Among 50 patients, 62% had a prominent HVS on FLAIR and 68% had prominent hypointense vessels on SWI. There was a moderate but significant correlation between the number of slices with HVS on FLAIR and prominent hypointense vessels on SWI (r=0.425, P = 0.002). In multivariate analyses, the prominence of hypointense vessels on SWI, but not HVS on FLAIR, was significantly associated with a higher discharge NIHSS score (P = 0.027), mRS score (P = 0.021), and lesion growth (P = 0.050). CONCLUSION The significant, albeit moderate, correlation between markers of compromised tissue perfusion on FLAIR and SWI suggests that these imaging features reflect different but interrelated aspects of cerebral hemodynamics during ischemic stroke. Our findings highlight that while HVS on FLAIR denotes the presence of leptomeningeal collaterals, hypointense vessels on SWI signify the sufficiency of cerebral blood flow at the tissue level and are therefore more critical in terms of prognosis.
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Affiliation(s)
- Atay Vural
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey.
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26
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Legrand L, Tisserand M, Turc G, Edjlali M, Calvet D, Trystram D, Roca P, Naggara O, Mas JL, Méder JF, Baron JC, Oppenheim C. Fluid-Attenuated Inversion Recovery Vascular Hyperintensities–Diffusion-Weighted Imaging Mismatch Identifies Acute Stroke Patients Most Likely to Benefit From Recanalization. Stroke 2016; 47:424-7. [DOI: 10.1161/strokeaha.115.010999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Fluid-attenuated inversion recovery vascular hyperintensities (FVH) beyond the boundaries of diffusion-weighted imaging (DWI) lesion (FVH-DWI mismatch) have been proposed as an alternative to perfusion-weighted imaging (PWI)-DWI mismatch. We aimed to establish whether FVH-DWI mismatch can identify patients most likely to benefit from recanalization.
Methods—
FVH-DWI mismatch was assessed in 164 patients with proximal middle cerebral artery occlusion before intravenous thrombolysis. PWI-DWI mismatch (PWI
Tmax>6sec
/DWI>1.8) was assessed in the 104 patients with available PWI data. We tested the associations between 24-hours complete recanalization on magnetic resonance angiography and 3-month favorable outcome (modified Rankin Scale score ≤2), stratified on FVH-DWI (or PWI-DWI) status.
Results—
FVH-DWI mismatch was present in 121/164 (74%) patients and recanalization in 50/164 (30%) patients. The odds ratio for favorable outcome with recanalization was 16.2 (95% confidence interval, 5.7–46.5;
P
<0.0001) in patients with FVH-DWI mismatch and 2.6 (95% confidence interval, 0.6–12.1;
P
=0.22) in those without FVH-DWI mismatch (
P
=0.048 for interaction). Recanalization was associated with favorable outcome in patients with PWI-DWI mismatch (odds ratios, 9.9; 95% confidence interval, 3.1–31.3;
P
=0.0001) and in patients without PWI-DWI mismatch (odds ratios, 7.0; 95% confidence interval, 1.1–44.1;
P
=0.047),
P
=0.76 for interaction.
Conclusion—
The FVH-DWI mismatch may rapidly identify patients with proximal occlusion most likely to benefit from recanalization.
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Affiliation(s)
- Laurence Legrand
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Marie Tisserand
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - David Calvet
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Denis Trystram
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Jean-Francois Méder
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France
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27
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Song J, Ma Z, Meng H, Yu J, Li Y, Hong X, Shi H. Distal hyperintense vessels alleviate insula infarction in proximal middle cerebral artery occlusion. Int J Neurosci 2015; 126:1030-5. [DOI: 10.3109/00207454.2015.1102139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Karadeli HH, Giurgiutiu DV, Cloonan L, Fitzpatrick K, Kanakis A, Ozcan ME, Schwamm LH, Rost NS. FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion. J Neuroimaging 2015; 26:219-23. [PMID: 26250448 DOI: 10.1111/jon.12274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/22/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. METHODS Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. RESULTS Among 39 patients (mean age 70.5 ± 12.7 years; 56% women, mean National Institutes of Health Stroke Scale score 17.2 (± 4.4)), median WMHV was 6.0 cm(3). FVH score and collateral flow grade were significantly correlated (Spearman's ρ = .41, P = .009). In a univariate regression model, FVH degree was inversely associated with WMHV (β = -.33, P = .04). CONCLUSIONS FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.
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Affiliation(s)
- Hasan H Karadeli
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA.,Department of Neurology, BezmialemVakıf University, Istanbul, Turkey
| | - Dan-Victor Giurgiutiu
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA.,University of Pittsburg Medical Center, Pittsburgh, PA
| | - Lisa Cloonan
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA
| | - Kaitlin Fitzpatrick
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA
| | - Allison Kanakis
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA.,University of Pittsburg Medical Center, Pittsburgh, PA
| | - Muhammed E Ozcan
- Department of Neurology, BezmialemVakıf University, Istanbul, Turkey
| | - Lee H Schwamm
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA
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29
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Kufner A, Galinovic I, Ambrosi V, Nolte CH, Endres M, Fiebach JB, Ebinger M. Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis. AJNR Am J Neuroradiol 2015; 36:1426-30. [PMID: 25977482 DOI: 10.3174/ajnr.a4320] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/08/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hyperintense vessels on baseline FLAIR MR imaging of patients with ischemic stroke have been linked to leptomeningeal collateralization, yet the ability of these to maintain viable ischemic tissue remains unclear. We investigated whether hyperintense vessels on FLAIR are associated with the severity of hypoperfusion and response to thrombolysis in patients treated with intravenous tissue-plasminogen activator. MATERIALS AND METHODS Consecutive patients with ischemic stroke with an MR imaging before and within 24 hours of treatment, with proved vessel occlusion and available time-to-maximum maps were included (n = 62). The severity of hypoperfusion was characterized on the basis of the hypoperfusion intensity ratio (volume with severe/mild hypoperfusion [time-to-maximum ≥ 8 seconds / time-to-maximum ≥ 2 seconds]). The hypoperfusion intensity ratio was dichotomized at the median to differentiate moderate (hypoperfusion intensity ratio ≤ 0.447) and severe (hypoperfusion intensity ratio > 0.447) hypoperfusion. Good outcome was defined as a modified Rankin Scale score of ≤2. RESULTS Hyperintense vessels on FLAIR were identified in 54 patients (87%). Patients with extensive hyperintense vessels on FLAIR (>4 sections) had higher NIHSS scores, larger baseline lesion volumes, higher rates of perfusion-diffusion mismatch, and more severe hypoperfusion (hypoperfusion intensity ratio). In stepwise backward multivariate regression analysis for the dichotomized hypoperfusion intensity ratio (including stroke etiology, age, perfusion deficit, baseline lesion volume, smoking, and extent of hyperintense vessels on FLAIR), extensive hyperintense vessels on FLAIR were independently associated with severe hypoperfusion (OR, 6.8; 95% CI, 1.1-42.7; P = .04). The hypoperfusion intensity ratio was an independent predictor of a worse functional outcome at 3 months poststroke (OR, 0.2; 95% CI, 0.5-0.6; P < .01). CONCLUSIONS Hyperintense vessels on FLAIR are associated with larger perfusion deficits, larger infarct growth, and more severe hypoperfusion, suggesting that hyperintense vessels on FLAIR most likely indicate severe ischemia as a result of insufficient collateralization.
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Affiliation(s)
- A Kufner
- From the Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., M. Endres, M. Ebinger) International Graduate Program Medical Neurosciences (A.K., V.A.)
| | - I Galinovic
- Center for Stroke Research Berlin (I.G., C.H.N., M. Endres, J.B.F., M. Ebinger), Berlin, Germany
| | - V Ambrosi
- International Graduate Program Medical Neurosciences (A.K., V.A.)
| | - C H Nolte
- From the Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., M. Endres, M. Ebinger) Center for Stroke Research Berlin (I.G., C.H.N., M. Endres, J.B.F., M. Ebinger), Berlin, Germany
| | - M Endres
- From the Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., M. Endres, M. Ebinger) Cluster of Excellence NeuroCure (M. Endres), Charité-Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (I.G., C.H.N., M. Endres, J.B.F., M. Ebinger), Berlin, Germany
| | - J B Fiebach
- Center for Stroke Research Berlin (I.G., C.H.N., M. Endres, J.B.F., M. Ebinger), Berlin, Germany
| | - M Ebinger
- From the Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., M. Endres, M. Ebinger) Center for Stroke Research Berlin (I.G., C.H.N., M. Endres, J.B.F., M. Ebinger), Berlin, Germany
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Park MG, Yang TI, Oh SJ, Baik SK, Kang YH, Park KP. Multiple hypointense vessels on susceptibility-weighted imaging in acute ischemic stroke: surrogate marker of oxygen extraction fraction in penumbra? Cerebrovasc Dis 2014; 38:254-61. [PMID: 25401484 DOI: 10.1159/000367709] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) are frequently observed in patients with acute cerebral ischemia, but their implication has not been clearly established. To elucidate the clinical significance of MHV on SWI, we investigated the association of MHV on SWI with clinical data and other MR markers in patients with acute ischemic stroke. METHODS We enrolled acute stroke patients with internal carotid or proximal middle cerebral artery occlusion who underwent MRI including SWI within 3 days from stroke onset. Baseline clinical data were reviewed. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). We graded the degree of MHV on SWI as four groups of none, subtle, relative, or extensive by the modified Alberta Stroke Program Early CT Scan (ASPECTS) system. To evaluate the degree of collateral flow, distal hyperintense vessels (DHV) on FLAIR and vessels on post-contrast time-of-flight MR angiography (TOF MRA) source images were graded respectively as 3 groups: none/subtle/prominent and poor/moderate/good. Diffusion and perfusion lesion volume and diffusion-perfusion mismatch (DPM) ratio were measured in all patients. We analyzed the association of the degree of MHV on SWI with clinical data and MR markers. RESULTS Eighty patients were included in the study. The mean MR time from stroke onset was 12.4 h (range 0.5-63.0). There is no difference in MR time from stroke onset between groups of MHV on SWI. MHV were observed in 68 (85%) of 80 patients: none in 12, subtle in 11, relative in 13, and extensive in 44. There were no statistically significant associations between MHV on SWI and vascular risk factors. Patients with more extensive MHV on SWI had a smaller diffusion volume (p < 0.001), larger DPM (p < 0.001), and lower initial NIHSS scores (p = 0.022). Prominent DHV was presented in 29 of 44 patients with extensive MHV (p < 0.001). Good collateral flow on TOF MRA source images was presented in 37 of 44 patients with extensive MHV (p < 0.001). CONCLUSIONS More extensive MHV on SWI in acute ischemic stroke is associated with lower initial NIHSS scores, smaller diffusion lesion volume, better collateral flow, and larger DPM. Our results show the possibility that MHV on SWI may be a useful surrogate marker for predicting increased oxygen extraction fraction and diffusion-perfusion mismatch in acute ischemic hemisphere.
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Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Gawlitza M, Gragert J, Quäschling U, Hoffmann KT. FLAIR-hyperintense vessel sign, diffusion-perfusion mismatch and infarct growth in acute ischemic stroke without vascular recanalisation therapy. J Neuroradiol 2014; 41:227-33. [DOI: 10.1016/j.neurad.2013.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
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Legrand L, Tisserand M, Turc G, Naggara O, Edjlali M, Mellerio C, Mas JL, Méder JF, Baron JC, Oppenheim C. Do FLAIR vascular hyperintensities beyond the DWI lesion represent the ischemic penumbra? AJNR Am J Neuroradiol 2014; 36:269-74. [PMID: 25190202 DOI: 10.3174/ajnr.a4088] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In acute stroke with proximal artery occlusion, FLAIR vascular hyperintensities observed beyond the boundaries of the cortical lesion on DWI (newly defined "FLAIR vascular hyperintensity-DWI mismatch") may be a marker of tissue at risk of infarction. Our aim was to compare the occurrence of FLAIR vascular hyperintensity-DWI mismatch relative to that of perfusion-weighted imaging-DWI mismatch in patients with proximal MCA occlusion before IV thrombolysis. MATERIALS AND METHODS In 141 consecutive patients with proximal MCA occlusion, 2 independent observers analyzed FLAIR images for the presence of FLAIR vascular hyperintensity-DWI mismatch before IV thrombolysis. PWI-DWI mismatch was defined as Volumehypoperfusion > 1.8 × VolumeDWI, with Volumehypoperfusion > 6 seconds on time to maximum value of the residue function maps in the 94 patients with available PWI. The presence of FLAIR vascular hyperintensity-DWI mismatch, PWI-DWI mismatch, and infarct growth on 24-hour follow-up DWI was compared. RESULTS A FLAIR vascular hyperintensity-DWI mismatch was present in 102/141 (72%) patients, with an excellent interobserver reliability (κ = 0.91), and a PWI-DWI mismatch, in 61 of the 94 (65%) patients with available PWI. FLAIR vascular hyperintensity-DWI mismatch predicted PWI-DWI mismatch with a sensitivity of 92% (95% CI, 85%-99%) and a specificity of 64% (95% CI, 47%-80%). Patients with FLAIR vascular hyperintensity-DWI mismatch had smaller initial DWI lesion and larger infarct growth (P < .001) than patients without FLAIR vascular hyperintensity-DWI mismatch, even though their final infarcts remained smaller (P < .001). CONCLUSIONS Albeit being moderately specific, probably due to inclusion of oligemic tissue, the FLAIR vascular hyperintensity-DWI mismatch identifies large PWI-DWI mismatch with high sensitivity.
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Affiliation(s)
- L Legrand
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - M Tisserand
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - G Turc
- Neurology (G.T., J.-L.M, J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - O Naggara
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - M Edjlali
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - C Mellerio
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - J-L Mas
- Neurology (G.T., J.-L.M, J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - J-F Méder
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
| | - J-C Baron
- Neurology (G.T., J.-L.M, J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - C Oppenheim
- From the Departments of Radiology (L.L., M.T., O.N., M.E., C.M., J.-F.M., C.O.)
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Arterial hyperintensity on BLADE fluid-attenuated inversion recovery images (FLAIR) in hyperacute territorial infarction: comparison with conventional FLAIR. Eur Radiol 2014; 24:2045-51. [DOI: 10.1007/s00330-014-3210-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/07/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Gawlitza M, Quäschling U, Hobohm C, Otto J, Voigt P, Hoffmann KT, Lobsien D. Hyperintense basilar artery on FLAIR MR imaging: diagnostic accuracy and clinical impact in patients with acute brain stem stroke. AJNR Am J Neuroradiol 2014; 35:1520-6. [PMID: 24812014 DOI: 10.3174/ajnr.a3961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome. MATERIALS AND METHODS We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness. RESULTS The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05). CONCLUSIONS The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.
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Affiliation(s)
- M Gawlitza
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - U Quäschling
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
| | - C Hobohm
- Neurology (C.H.), University Hospital Leipzig, Leipzig, Germany
| | - J Otto
- Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - P Voigt
- Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - K-T Hoffmann
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
| | - D Lobsien
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
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Automatic detection and quantification of acute cerebral infarct by fuzzy clustering and histographic characterization on diffusion weighted MR imaging and apparent diffusion coefficient map. BIOMED RESEARCH INTERNATIONAL 2014; 2014:963032. [PMID: 24738080 PMCID: PMC3971548 DOI: 10.1155/2014/963032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/31/2013] [Accepted: 01/09/2014] [Indexed: 12/16/2022]
Abstract
Determination of the volumes of acute cerebral infarct in the magnetic resonance imaging harbors prognostic values. However, semiautomatic method of segmentation is time-consuming and with high interrater variability. Using diffusion weighted imaging and apparent diffusion coefficient map from patients with acute infarction in 10 days, we aimed to develop a fully automatic algorithm to measure infarct volume. It includes an unsupervised classification with fuzzy C-means clustering determination of the histographic distribution, defining self-adjusted intensity thresholds. The proposed method attained high agreement with the semiautomatic method, with similarity index 89.9 ± 6.5%, in detecting cerebral infarct lesions from 22 acute stroke patients. We demonstrated the accuracy of the proposed computer-assisted prompt segmentation method, which appeared promising to replace the laborious, time-consuming, and operator-dependent semiautomatic segmentation.
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Seo KD, Lee KO, Choi YC, Kim WJ, Lee KY. Fluid-attenuated inversion recovery hyperintense vessels in posterior cerebral artery infarction. Cerebrovasc Dis Extra 2013; 3:46-54. [PMID: 24052794 PMCID: PMC3776708 DOI: 10.1159/000350459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are known to reflect stagnant or slow blood flow within the cerebral artery. FHVs are frequently observed in patients with acute cerebral infarction accompanied by arterial occlusion or significant stenosis of the anterior cerebral circulation. However, FHVs have not been studied in the context of posterior cerebral circulation. Thus, we investigated the prevalence of FHVs and its clinical significance in patients with acute posterior cerebral artery (PCA) territory infarction. Methods In this retrospective study, consecutive patients with PCA territory infarction who underwent MRI within 1 week after symptom onset were enrolled. Two neurologists who were blinded to the angiographic findings read the images and determined the presence of FHVs. Afterwards, FHVs were graded according to the extent (subtle or prominent) and location (proximal or distal) of the hyperintense vessels. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) upon admission and after 5 days. The clinical outcome between patient groups based on FHVs grading was compared using the NIHSS. Among the patients with PCA occlusion, infarction volume on the diffusion-weighted image was compared between the two groups with and without distal FHVs. Results FHVs were observed in 25 of the 87 patients (28.7%) with PCA territory infarction and in 65.7% of the 35 patients with significant arterial stenosis (10 patients) or occlusion (25 patients) in the posterior cerebral circulation. Among the 18 patients with PCA occlusion, the NIHSS score was significantly improved in patients with distal FHVs compared to the others (2.00 ± 2.18 vs. 0.56 ± 1.01, p = 0.04). The infarction volume was smaller in the distal FHV group than in the others (8.3 ± 8.7 vs. 16.8 ± 17.6 ml), but the difference was not statistically significant. Conclusions FHVs are detected in patients with PCA territory infarction, especially in those with an occlusive lesion in the PCA. FHVs can be used as an imaging marker of PCA occlusion. Although this study showed a better clinical improvement in patients with distal FHVs, further study is needed to elucidate the clinical meaning of FHVs in PCA infarction.
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Affiliation(s)
- Kwon-Duk Seo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Daejeon, Korea
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