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Gaeta M, Galletta K, Cavallaro M, Mormina E, Cannizzaro MT, Lanzafame LRM, D'Angelo T, Blandino A, Vinci SL, Granata F. T1 relaxation: Chemo-physical fundamentals of magnetic resonance imaging and clinical applications. Insights Imaging 2024; 15:200. [PMID: 39120775 PMCID: PMC11315875 DOI: 10.1186/s13244-024-01744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
A knowledge of the complex phenomena that regulate T1 signal on Magnetic Resonance Imaging is essential in clinical practice for a more effective characterization of pathological processes. The authors review the physical basis of T1 Relaxation Time and the fundamental aspects of physics and chemistry that can influence this parameter. The main substances (water, fat, macromolecules, methemoglobin, melanin, Gadolinium, calcium) that influence T1 and the different MRI acquisition techniques that can be applied to enhance their presence in diagnostic images are then evaluated. An extensive case illustration of the different phenomena and techniques in the areas of CNS, abdomino-pelvic, and osteoarticular pathology is also proposed. CRITICAL RELEVANCE STATEMENT: T1 relaxation time is strongly influenced by numerous factors related to tissue characteristics and the presence in the context of the lesions of some specific substances. An examination of these phenomena with extensive MRI exemplification is reported. KEY POINTS: The purpose of the paper is to illustrate the chemical-physical basis of T1 Relaxation Time. MRI methods in accordance with the various clinical indications are listed. Several examples of clinical application in abdominopelvic and CNS pathology are reported.
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Affiliation(s)
- Michele Gaeta
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Karol Galletta
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | | | | | - Tommaso D'Angelo
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Alfredo Blandino
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
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Xin Y, Zhou H, Xue MC, Wang Q, Zhou SL, Zhou XY, Ji TJ. Correlation of fluid-attenuated inversion recovery sequence vascular hyperintensity in magnetic resonance with collateral circulation and short-term clinical prognosis in acute ischemic stroke. Quant Imaging Med Surg 2024; 14:4123-4133. [PMID: 38846311 PMCID: PMC11151264 DOI: 10.21037/qims-23-1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/12/2024] [Indexed: 06/09/2024]
Abstract
Background Accurately assessing the prognosis of patient with large-scale cerebral infarction caused by acute middle cerebral artery (MCA) occlusion in the early stages of onset can help clinicians to actively and effectively intervene, thus reducing mortality and disability rates. This study set out to investigate the predictive value of fluid-attenuated inversion recovery vascular hyperintensity (FVH) on collateral circulation and clinical prognosis. Methods The clinical data of 70 patients admitted to The First People's Hospital of Lianyungang from January 2018 to December 2021 with acute cerebral infarction due to occlusion of the proximal end of the M1 segment in the MCA were retrospectively collected. All patients had their first onset of disease and did not receive thrombolytic therapy at the time of onset. Subsequently, they underwent endovascular thrombectomy for treatment. The FVH and collateral vessel scores were derived according to patients' fluid-attenuated in version recovery (FLAIR) sequence and time-of-flight magnetic resonance angiography images. Based on the 90-day Modified Rankin Scale (mRS), patients were allocated to a good prognosis group (mRS ≤2) and a poor prognosis group (mRS =3-6). The correlation between the FVH and collateral vessel scores was assessed using the Spearman rank correlation test. Pearson correlation coefficient analysis was used to assess the correlation between FVH and the 90-day mRS together with the infarct size. Univariate analysis, multivariate binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were adopted to identify those factors potentially. associated with the prognosis of patients with acute ischemic stroke (AIS). Results Out of 70 patients with acute unilateral MCA occlusion (MCAO) who met the inclusion criteria, 62 showed positive FVH sign. These 62 patients were divided into a good prognosis group (n=32) and a poor prognosis group (n=30) based on the mRS score 90 days after discharge. The Spearman rank correlation test indicated that FVH was positively correlated with collateral vessel grade (Spearman rho =0.865; P<0.001); meanwhile, Pearson correlation coefficient analysis indicated that FVH score had moderate negative correlation with 90-day mRS score (r=-0.605; P<0.001). The results of multivariate binary logistic regression analysis indicated that collateral vessel grade and FVH score may be associated with the prognosis of patients with AIS, and the area under the curve (AUC) of FVH score was larger than collateral vessel grade (AUC =0.738). Conclusions There was a positive correlation between FVH score and collateral vessel grade, and FVH score could indicate collateral circulation. FVH score was negatively correlated with 90-day mRS score and infarct volume and thus can predict clinical prognosis.
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Affiliation(s)
- Yi Xin
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Hang Zhou
- Department of Hematology, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Ming-Chen Xue
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Qian Wang
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Sheng-Li Zhou
- Department of Medical Imaging, The First People’s Hospital of Guannan County, Lianyungang, China
| | - Xin-Yu Zhou
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Ting-Ju Ji
- Department of Medical Imaging, The First People’s Hospital of Guannan County, Lianyungang, China
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Bu J, Han X, Wu Y, Lv H, Feng X, Gao D. Correlation between asymmetrical vein sign of SWI and long-term clinical outcomes in patients with middle cerebral artery ischemic stroke. Jpn J Radiol 2024:10.1007/s11604-024-01596-2. [PMID: 38805116 DOI: 10.1007/s11604-024-01596-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To evaluate the association of asymmetrical cortical vein sign (ACVS) and asymmetrical medullary vein sign (AMVS) on susceptibility-weighted imaging (SWI) with 90-day poor outcomes in patients with unilateral middle cerebral artery acute ischemic stroke (AIS) after conservative drug treatment. METHODS Clinical data for the participants included age, sex, smoking, alcohol, hypertension, diabetes, hyperlipidemia, coronary heart disease, NHISS-admission, and NHISS-discharge scores. Participants underwent magnetic resonance imaging (MRI) within 12 h of hospital admission, including conventional scan sequences and a SWI sequence. Poor prognosis was defined as a modified Rankin scale (mRS) ≥ 3 at 90 days. RESULTS A total of 108 patients were included from January 2021 to March 2022. Twenty-seven (25%) patients had a poor outcome at 90 days. Univariate analysis indicated that diabetes, NHISS-admission, NHISS-discharge, DWI-ASPECTS, SWI-ASPECTS, FLAIR-ASPECTS, and AMVS + were associated with 90-day poor outcome. Multivariate regression analysis showed that AMVS + was associated with 90-day poor outcome from the three models (OR = 3.57, P = 0.006; OR = 3.74, P = 0.005; OR = 5.14, P = 0.0057). However, no significant association was found between ACVS + and 90-day poor outcome. CONCLUSIONS AMVS might be a helpful neuroimaging predictor for poor outcome at 90 days compared to ACVS in drug-conserving treatment of patients with unilateral middle cerebral artery ischemic stroke.
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Affiliation(s)
- Jingying Bu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuefang Han
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Yankai Wu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Huandi Lv
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Xuran Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China
| | - Duo Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping West Street, Shijiazhuang, 050000, China.
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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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Xiang W, Wei H, Liang Z, Zhang M, Sun Z, Lv Y, Zhang C, Zheng H. FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome. Eur J Med Res 2023; 28:446. [PMID: 37853442 PMCID: PMC10585931 DOI: 10.1186/s40001-023-01445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND To investigate the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH) within asymmetrical prominent veins sign (APVS) on susceptibility-weighted imaging predicting collateral circulation and prognosis in patients with acute anterior circulation ischemic stroke. METHOD Patients with severe stenosis or occlusion of ICA or MCA M1, who underwent MRI within 72 h from stroke onset were reviewed. The Alberta Stroke Program Early CT Score was used to evaluate the volume of infarction on DWI, the degree of FVH and APVS. Spearman correlation analysis was used to evaluate the correlation between FVH and APVS. All patients were divided into the good prognosis group and the poor prognosis group according to the score of the modified ranking scale (mRS) 90 days after the stroke. Logistic regression analysis was used to explore the relationship between FVH and APVS and functional prognosis, while receiver operating characteristic (ROC) curves were plotted to assess the value of FVH and APVS in predicting prognosis. RESULTS Spearman correlation analysis revealed moderate positive correlations between FVH and APVS (r = 0.586, P < 0.001). The poor prognosis group had a higher rate of a history of atrial fibrillation, a larger cerebral infarction volume, a higher NIHSS score at admission, and a higher FVH and APVS score compared with the good prognosis group (all P < 0.05). A further logistic regression indicated that the NIHSS score, cerebral infarction volume, FVH and APVS were independent risk factors for a poor functional prognosis. In terms of FVH, APVS, alone and their combination for the diagnosis of poor prognosis, the sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (CI) were 86.8%, 83.3%, 0.899 (95% CI 0.830-0.968); 60.5%, 93.7%, 0.818 (95% CI 0.723-0.912); 86.8%, 89.6%, 0.921 (95% CI 0.860-0.981), respectively. CONCLUSION The presence of FVH and APVS can provide a comprehensive assessment of collateral circulation from the perspective of veins and arteries, and the correlation between the two is positively correlated. Both of them were independent risk factors for poor prognosis, their combination is complementary and can improve the predictive value.
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Affiliation(s)
- Wei Xiang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Hongchun Wei
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Zhigang Liang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China.
| | - Manman Zhang
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Zhongwen Sun
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Yaodong Lv
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Chengzhou Zhang
- Department of Radiology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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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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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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Ouyang F, Wang B, Wu Q, Yang Q, Meng X, Liu J, Xu Z, Lv L, Zeng X. Association of intravascular enhancement sign detected on high-resolution vessel wall imaging with ischaemic events in middle cerebral artery occlusion. Eur J Radiol 2023; 165:110922. [PMID: 37320882 DOI: 10.1016/j.ejrad.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Patients with intracranial artery occlusion have high rates of ischaemic events and recurrence. Early identification of patients with high-risk factors is therefore beneficial for prevention. Here we assessed the association between the intravascular enhancement sign (IVES) on high-resolution vessel wall imaging (HR-VWI) and acute ischaemic stroke (AIS) in a population with middle cerebral artery (MCA) occlusion. METHOD We retrospectively analysed the records of 106 patients with 111 MCA occlusions, including 60 with and 51 without AIS, who had undergone HR-VWI and computed tomography angiography (CTA) examinations from November 2016 to February 2023. Numbers of IVES vessels were counted and compared to the CTA findings. Statistical analyses of demographic and medical data were also performed. RESULTS Occurrence rates and numbers of IVES vessels were significantly higher in the AIS than the non-AIS group (P < 0.05), and most vessels were detected on CTA. Numbers of vessels positively correlated with AIS occurrence (rho = 0.664; P < 0.0001). A multivariable ordinal logistic regression model adjusted for age, degree of wall enhancement, hypertension, and heart status identified the number of IVES vessels as an independent predictor for AIS (odds ratio = 1.6; 95% CI, 1.3-1.9; P < 0.0001). CONCLUSION Number of IVES vessels is an independent risk factor for AIS events, and may represent poor cerebral blood flow status and collateral compensation level. It thus provides cerebral haemodynamic information for patients with MCA occlusion for clinical use.
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Affiliation(s)
- Feng Ouyang
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Bo Wang
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Qin Wu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Qiao Yang
- Department of Neurology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Xiangqiang Meng
- Department of Rehabilitation Medicine, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Jie Liu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Zihe Xu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Lianjiang Lv
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Xianjun Zeng
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China.
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Patel LD, Raghavan P, Tang S, Choi S, Harrison DM. Imaging of the meningeal lymphatic network in healthy adults: A 7T MRI study. J Neuroradiol 2023; 50:369-376. [PMID: 36918053 PMCID: PMC10981496 DOI: 10.1016/j.neurad.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND AND PURPOSE Meningeal lymphatic vessels (MLVs) along the dural venous sinuses are suspected to be important in connecting the glymphatic and peripheral lymphatic system. Understanding the topography of MLVs may clarify the role of the glymphatic system in neurological diseases. The aim of this analysis was to use high resolution pre- and post-contrast FLAIR 7T MRI to identify and characterize the morphology of MLV in a cohort of healthy volunteers. MATERIALS AND METHODS MRI examinations of seventeen healthy volunteers enrolled as controls in a larger 7T MRI study were reviewed. Pre- and post-contrast 3-D FLAIR subtractions and MP2RAGE sequences were spatially normalized and reviewed for signal intensity and enhancement patterns within putative MLVs along pre-determined dural and venous structures. Frequency of occurrence of MLVs at the above-described locations and patterns of their enhancement were analyzed. RESULTS Putative MLVs are commonly located along the superior sagittal sinus (SSS) and cortical veins. A "fixed enhancement" signal pattern was more frequent at these locations (p<.05). The morphology of MLVs along the SSS qualitatively changes in an antero-posterior direction. Lack of signal was more frequent along the straight and transverse sinuses (p<.05). CONCLUSION Putative MLVs in healthy individuals are concentrated along the SSS and cortical veins. FLAIR signal and enhancement characteristics suggest these structures may transport proteinaceous fluid. Pathways connecting MLVs to cervical lymph nodes however remain unclear.
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Affiliation(s)
- Lakir D Patel
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Prashant Raghavan
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Shiyu Tang
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA; University of Maryland School of Medicine, Center for Advanced Imaging Research (CAIR), Baltimore, Maryland, USA.
| | - Seongjin Choi
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA.
| | - Daniel M Harrison
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA; Baltimore VA Medical Center, Baltimore, Maryland, USA.
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Kaewumporn U, Songsaeng D, Kunapinun A, Chaisinanunkul N. FLAIR vascular hyperintensity-DWI mismatch and DWI-FLAIR mismatch ASPECTS for prediction of good outcome after recanalization in anterior circulation stroke; multicenter observational study. Eur J Radiol 2023; 163:110837. [PMID: 37084592 DOI: 10.1016/j.ejrad.2023.110837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Acute ischemic stroke is a medical emergency caused by decreased blood flow to the brain, leading cause of long-term disability. Recanalization, one of the most concerning difficulties linked with intracranial arterial occlusion, has been used to reduce mortality in ischemic stroke treatment. The mismatch concepts MR PWI-DWI or DWI-FLAIR can help identify patients for thrombolysis. PURPOSE This paper introduces a novel method of predicting revascularization using the value of fluid-attenuated inversion recovery vascular hyperintensity FVH-DWI mismatch and DWI-FLAIR mismatch, which releases anterior circulation large vessel occlusion (LVO) after endovascular thrombectomy (EVT). Moreover, we present a new scoring system following anatomical region distributed for MCA territory called a DWI-FLAIR MISMATCH ASPECTS. RESULT Statistical analysis was performed to predict revascularization and functional outcome with 110 patients with anterior circulation LVO treated with EVT. We found that FVH-DWI mismatch was present in 71 patients (89.9 %) with complete revascularization and present in 8 patients (10.1 %) with no/partial revascularization, which had no significant difference (p = 0.12), and there was no significant difference between good functional outcome and poor functional outcome. Moreover, in 76 patients with DWI-FLAIR mismatch ASPECTS of > 6 point-group, present FVH-DWI mismatch in 57 patients (83.8 %) with complete revascularization had a significant difference as compared to 11 patients (16.2 %) with absent FVH-DWI mismatch (p < 0.05). The clinical outcome in complete revascularization is better than no/partial revascularization, and complete revascularization is independently associated with good functional outcomes (p < 0.05). CONCLUSION FVH-DWI mismatch paired with DWI-FLAIR mismatch ASPECTS > 6 points may be possible to predict revascularization in patients with anterior circulation LVO.
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Affiliation(s)
- Utarat Kaewumporn
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand
| | - Dittapong Songsaeng
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand.
| | - Alisa Kunapinun
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand
| | - Napasri Chaisinanunkul
- Phyathai 1 Stroke Center, Phyathai 1 Hospital, 364/1, Phaya Thai Road, Ratchathewi, Bangkok 10400, Thailand
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11
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Legrand L, Le Berre A, Seners P, Benzakoun J, Ben Hassen W, Lion S, Boulouis G, Cottier JP, Costalat V, Bracard S, Berthezene Y, Ozsancak C, Provost C, Naggara O, Baron JC, Turc G, Oppenheim C. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters. AJNR Am J Neuroradiol 2023; 44:26-32. [PMID: 36521962 PMCID: PMC9835925 DOI: 10.3174/ajnr.a7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.
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Affiliation(s)
- L Legrand
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - A Le Berre
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - P Seners
- Department of Neurology (P.S.), Hôpital Fondation Rothschild, Paris, France
| | - J Benzakoun
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - W Ben Hassen
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - S Lion
- Edmus Services (S.L.), Fondation Edmus, Lyon, France
| | - G Boulouis
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - J-P Cottier
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - V Costalat
- Department of Interventional Neuroradiology (V.C.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S Bracard
- Department of Diagnostic and Interventional Neuroradiology (S.B.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U947, Nancy, France
| | - Y Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Lyon, France
| | - C Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, Orleans, France
| | - C Provost
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - O Naggara
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - J-C Baron
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - G Turc
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Oppenheim
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
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12
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Akiyama T, Okuda T, Inoha S. Lessons Learned from Mechanical Thrombectomy of an Acute Occlusion of a Duplicated Middle Cerebral Artery: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:510-514. [PMID: 37502205 PMCID: PMC10370823 DOI: 10.5797/jnet.cr.2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 07/29/2023]
Abstract
Objective Detection of acute arterial occlusion in an anomalous middle cerebral artery (MCA) is challenging in an emergency setting because of its rarity. Case Presentation We report an 81-year-old woman who presented with acute occlusion of a duplicated middle cerebral artery (DMCA). Although the absence of the superior trunk of the left MCA was identified on preoperative imaging, initial angiography showed no typical sign of the occluded vessel. Repeated angiography eventually revealed retrograde arterial flow parallel to the other visible MCA trunk, which raised the possibility of a DMCA. The occlusion occurred at the origin of the DMCA originating from the internal carotid artery terminus, which obscured its presence. Mechanical thrombectomy was performed and achieved complete recanalization. The DMCA had two trunks of approximately equal size. The patient completely recovered within 90 days. Conclusion Comprehensive knowledge of cerebrovascular anomalies is essential to identify the occluded branch faster and accurately and to avoid thrombectomy-related complications in endovascular recanalization therapy. Relevant DMCA anatomy and tips for identifying an occluded DMCA are discussed.
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Affiliation(s)
- Tomoaki Akiyama
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Tomohiro Okuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Satoshi Inoha
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
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Salahuddin H, Saherwala A, Pinho MC, Moore W, Castonguay A, Khan NI, Jeelani F, Uppal H, He H, Campbell J, Shang T. Association of distal hyperintense vessel sign and recurrent stroke in patients with symptomatic intracranial stenosis. J Stroke Cerebrovasc Dis 2022; 31:106616. [PMID: 35816788 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106616] [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: 04/18/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The distal hyperintense vessel sign (DHV) on fluid-attenuated inversion recovery magnetic resonance image (MRI) is an imaging biomarker of slow leptomeningeal collateral flow in the presence of large artery stenosis or occlusion reflecting impaired cerebral hemodynamics. In this study, we aim to investigate the significance of the DHV sign in patients with symptomatic ≥ 70% intracranial atherosclerotic stenosis. METHODS We retrospectively reviewed patients with ischemic stroke or transient ischemic attack admitted to a single center from January 2010 to December 2017. Patients were included if they had symptomatic ≥ 70% atherosclerotic stenosis of the intracranial internal carotid artery or middle cerebral artery. The presence of the DHV sign was evaluated by blinded neuroradiologist and vascular neurologists. Recurrent ischemic stroke in the vascular territory of symptomatic intracranial artery was defined as new neurological deficits with associated neuroimaging findings during the follow up period. RESULTS A total of 109 patients were included in the study, of which 55 had DHV sign. Average duration of follow up was 297 ± 326 days. Four patients were lost during follow up. Patients with the DHV sign had a higher rate of recurrent ischemic stroke (38%), compared to patients without the DHV sign (17%; p=0.018). In multivariate regression analysis, the presence of DHV sign was an independent predictor of recurrent ischemic stroke. A DHV score of ≥ 2 had a 63% sensitivity and 69% specificity for recurrent ischemic stroke. INTERPRETATION In patients with severe symptomatic intracranial atherosclerotic stenosis, those with a DHV sign on MRI are at higher risk of recurrent ischemic stroke.
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Affiliation(s)
- Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA USA; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA; Department of Neurology, University of Toledo, Toledo, OH USA
| | - Ali Saherwala
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Marco C Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA.
| | - William Moore
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA.
| | | | - Nadeem I Khan
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Faraz Jeelani
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Hardeep Uppal
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA.
| | - Henry He
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA.
| | - Joel Campbell
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Ty Shang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA.
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Bunker LD, Walker A, Meier E, Goldberg E, Leigh R, Hillis AE. Hyperintense vessels on imaging account for neurological function independent of lesion volume in acute ischemic stroke. Neuroimage Clin 2022; 34:102991. [PMID: 35339984 PMCID: PMC8957047 DOI: 10.1016/j.nicl.2022.102991] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Studies have revealed variable significance of FLAIR hyperintense vessels (FHV). We found number and location of FHV are associated with functional deficits. Functional measures correlated with FHV independently of lesion volume.
In acute ischemic stroke, reported relationships between lesion metrics and behavior have largely focused on lesion volume and location. However, hypoperfusion has been shown to correlate with deficits in the acute stage. Hypoperfusion is typically identified using perfusion imaging in clinical settings, which requires contrast. Unfortunately, contrast is contraindicated for some individuals. An alternative method has been proposed to identify hypoperfusion using hyperintense vessels on fluid-attenuated inversion recovery (FLAIR) imaging. This study aimed to validate the clinical importance of considering hypoperfusion when accounting for behavior in acute stroke and demonstrate the clinical utility of scoring the presence of hyperintense vessels to quantify it. One hundred and fifty-three participants with acute ischemic stroke completed a battery of commonly-used neurological and behavioral measures. Clinical MRIs were used to determine lesion volume and to score the presence of hyperintense vessels seen on FLAIR images to estimate severity of hypoperfusion in six different vascular regions. National Institutes of Health Stroke Scale (NIHSS) scores, naming accuracy (left hemisphere strokes), and language content produced during picture description were examined in relation to lesion volume, hypoperfusion, and demographic variables using correlational analyses and multivariable linear regression. Results showed that lesion volume and hypoperfusion, in addition to demographic variables, were independently associated with performance on NIHSS, naming, and content production. Specifically, hypoperfusion in the frontal lobe independently correlated with NIHSS scores, while hypoperfusion in parietal areas independently correlated with naming accuracy and content production. These results correspond to previous reports associating hypoperfusion with function, confirming that hypoperfusion is an important consideration—beyond lesion volume—when accounting for behavior in acute ischemic stroke. Quantifying hypoperfusion using FLAIR hyperintense vessels can be an essential clinical tool when other methods of identifying hypoperfusion are unavailable or time prohibitive.
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Affiliation(s)
- Lisa D Bunker
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Alexandra Walker
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Erin Meier
- Northeastern University Bouvé College of Health Sciences, Department of Communication Sciences and Disorders, Boston, MA 02115, USA
| | - Emily Goldberg
- University of Pittsburgh, Department of Communication Science and Disorders, Pittsburgh, PA 15260, USA
| | - Richard Leigh
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA. https://twitter.com/@HopkinsSKSI
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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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16
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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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Sattenberg RJ, Atchaneeyasakul K, Meckler J, Saver JL, Gobin YP, Liebeskind DS. Cerebral Angiography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Imai M, Shimoda M, Oda S, Hoshikawa K, Osada T, Aoki R, Sunaga A. Hyperintense posterior cerebral artery sign in patients with reversible cerebral vasoconstriction syndrome. Surg Neurol Int 2021; 12:558. [PMID: 34877044 PMCID: PMC8645486 DOI: 10.25259/sni_1023_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background: This study investigated hyperintense vessel signs (HVS) on fluid-attenuated inversion recovery imaging in the P1–2 portions of posterior cerebral arteries (PCAs) as a “hyperintense PCA sign” and HVS of cortical arteries. We retrospectively examined whether these signs would be useful in diagnosing reversible cerebral vasoconstriction syndrome (RCVS) in the acute phase. Methods: Eighty patients with RCVS who underwent initial magnetic resonance imaging (MRI) within 7 days of onset were included in this study. HVS and related clinical factors were examined. Results: On initial MRI of RCVS patients, hyperintense PCA sign and HVS of cortical arteries were seen in 21 cases (26%) and 38 cases (48%), respectively. In patients showing hyperintense PCA sign, vasoconstriction of the A2–3 portion was a significant clinical factor. Conversely, vasoconstriction of the M1 and P1 portions and the presence of white matter hyperintensity on initial and chronic-stage MRI were significantly associated with the presence of HVS in cortical arteries. Conclusion: Because rich collateral flow exists around PCAs, the frequency of hyperintense PCA sign is not high. However, hyperintense PCA sign findings in patients with suspected RCVS offer credible evidence of extreme flow decreases due to vasoconstriction in peripheral PCAs and other arteries associated with the collateral circulation of PCAs. Conversely, HVS in cortical arteries tend to reflect slow antegrade circulation due to vasoconstriction of peripheral vessel and major trunks. Both signs appear useful for auxiliary diagnosis of acute-phase RCVS.
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Affiliation(s)
- Masaaki Imai
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Masami Shimoda
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Shinri Oda
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Kaori Hoshikawa
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Takahiro Osada
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
| | - Azusa Sunaga
- Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan
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Collateral estimation by susceptibility-weighted imaging and prediction of functional outcomes after acute anterior circulation ischemic stroke. Sci Rep 2021; 11:21370. [PMID: 34725373 PMCID: PMC8560757 DOI: 10.1038/s41598-021-00775-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/14/2021] [Indexed: 12/14/2022] Open
Abstract
To determine the value of susceptibility-weighted imaging (SWI) for collateral estimation and for predicting functional outcomes after acute ischemic stroke. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, SWI collateral grade, mode of treatment, and successful reperfusion were evaluated by multiple logistic regression analyses. A total of 152 participants were evaluated. A younger age (adjusted odds ratio (aOR), 0.42; 95% confidence interval (CI) 0.34 to 0.77; P < 0.001), a lower baseline NIHSS score (aOR 0.90; 95% CI 0.82 to 0.98; P = 0.02), a smaller baseline DWI lesion volume (aOR 0.83; 95% CI 0.73 to 0.96; P = 0.01), an intermediate collateral grade (aOR 9.49; 95% CI 1.36 to 66.38; P = 0.02), a good collateral grade (aOR 6.22; 95% CI 1.16 to 33.24; P = 0.03), and successful reperfusion (aOR 5.84; 95% CI 2.08 to 16.42; P = 0.001) were independently associated with a favorable functional outcome. There was a linear association between the SWI collateral grades and functional outcome (P = 0.008). Collateral estimation using the prominent vessel sign on SWI is clinically reliable, as it has prognostic value.
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Diagnosis of extracranial carotid stenosis by MRA of the brain. Sci Rep 2021; 11:12010. [PMID: 34103593 PMCID: PMC8187356 DOI: 10.1038/s41598-021-91511-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Severe extracranial carotid stenosis (SECS) patients may present with nonspecific neurological symptoms that require intracranial magnetic resonance imaging (MRI) and time-of-flight (TOF)-MR angiography (MRA) to exclude intracranial pathology. Recognition of SECS on intracranial TOF-MRA findings is beneficial to provide a prompt carotid imaging study and aggressive stroke prevention. Patients with SECS (January 2016 to May 2019) undergoing percutaneous transluminal angioplasty and stenting (PTAS) were included. Differences in normalized signal intensities (SRICA) and diameters (DICA) between bilateral petrous internal carotid arteries (ICAs) were calculated 1 cm from the orifice. A hypothesized criterion describing the opacification grades (GOPH) of bilateral ophthalmic arteries was proposed. We correlated SRICA (p = 0.041), DICA (p = 0.001) and GOPH (p = 0.012), with the severity of extracranial carotid stenosis on digital subtractive angiography (DSA) in the examined group (n = 113), and all showed statistical significance in predicting percentages of ICA stenosis. The results were further validated in another patient group with SECS after radiation therapy (n = 20; p = 0.704 between the actual and predicted stenosis grades). Our findings support the evaluation of the signal ratio and diameter of intracranial ICA on TOF-MRA to achieve early diagnosis and provide appropriate management of SECS.
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Abstract
Multimodal MR imaging provides valuable information in the management of patients with acute ischemic stroke (AIS), with diagnostic, therapeutic, and prognostic implications. MR imaging plays a critical role in treatment decision making for (1) thrombolytic treatment of AIS patients with unknown symptom-onset and (2) endovascular treatment of patients with large vessel occlusion presenting beyond 6 hours from the symptom onset. MR imaging provides the most accurate information for detection of ischemic brain and is invaluable for differentiating AIS from stroke mimics.
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Wang LX, Wang H, Hao FB, Lv JH, Zhang SH, Han DS, Bian XB, Zhang DK, Lan YN, Wang XR, Wei MT, Duan L, Ma L, Lou X. Ivy Sign in Moyamoya Disease: A Comparative Study of the FLAIR Vascular Hyperintensity Sign Against Contrast-Enhanced MRI. AJNR Am J Neuroradiol 2021; 42:694-700. [PMID: 33664105 DOI: 10.3174/ajnr.a7010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The ability of the ivy sign on contrast-enhanced T1-weighted MR imaging (CEMR) to reflect cerebral perfusion and postoperative revascularization in Moyamoya disease remains largely unknown. We aimed to compare the capabilities of CEMR and FLAIR. MATERIALS AND METHODS CEMR, FLAIR, arterial spin-labeling, and DSA were performed in 44 patients with Moyamoya disease. The ivy sign was scored separately on CEMR and FLAIR using the Alberta Stroke Program Early CT Score. The status of leptomeningeal collaterals was scored on DSA. The postoperative Matsushima grade was evaluated at least 3 months after surgical revascularization. RESULTS Scoring of the ivy sign on CEMR showed excellent interrater reliability, and FLAIR vascular hyperintensity showed moderate interrater reliability. Correlation analyses revealed that DSA scores were more consistent with the CEMR-based ivy sign score (r = 0.25, P = .03) than with FLAIR vascular hyperintensity (r = 0.05, P = .65). The CEMR-based ivy sign score was significantly correlated with CBF in late-Suzuki stage Moyamoya disease (t = -2.64, P = .02). The CEMR-based ivy sign score at baseline was significantly correlated with the postoperative Matsushima grade (r = 0.48, P = .03). CONCLUSIONS In this study, CEMR outperformed FLAIR in capturing the ivy sign in Moyamoya disease. In addition, the CEMR-based ivy sign score provided adequate information on hemodynamic status and postoperative neovascularization. The current study suggested that CEMR could be considered as an alternative to FLAIR in future studies investigating leptomeningeal collaterals in Moyamoya disease.
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Affiliation(s)
- L-X Wang
- From the Medical School of Chinese PLA (L.-X.W., S.-H.Z., D.-S.H.), Beijing, China.,Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - H Wang
- Department of Neurosurgery (H.W., F.-B.H., L.D.), the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - F-B Hao
- Department of Neurosurgery (H.W., F.-B.H., L.D.), the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - J-H Lv
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - S-H Zhang
- From the Medical School of Chinese PLA (L.-X.W., S.-H.Z., D.-S.H.), Beijing, China.,Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - D-S Han
- From the Medical School of Chinese PLA (L.-X.W., S.-H.Z., D.-S.H.), Beijing, China.,Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - X-B Bian
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - D-K Zhang
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y-N Lan
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - X-R Wang
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - M-T Wei
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - L Duan
- Department of Neurosurgery (H.W., F.-B.H., L.D.), the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - L Ma
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - X Lou
- Department of Radiology (L.-X.W., J.-H.L., S.-H.Z., D.-S.H., X.-B.B., D.-K.Z., Y.-N.L., X.-R.W., M.-T.W., X.L., L.M.), the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Wang E, Wu C, Yang D, Zhao X, Zhao J, Chang H, Yang Q. Association between fluid-attenuated inversion recovery vascular hyperintensity and outcome varies with different lesion patterns in patients with intravenous thrombolysis. Stroke Vasc Neurol 2021; 6:449-457. [PMID: 33593984 PMCID: PMC8485239 DOI: 10.1136/svn-2020-000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity (FVH) after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging (DWI). Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed. They were divided into four groups by DWI lesion patterns: border-zone infarct (BZ group), multiple lesions infarct (ML group), large territory infarct (LT group), and single cortical or subcortical lesion infarct (SL group). Logistic regression was performed to identify risk factors for outcome (unfavourable outcome, modified Rankin Scale (mRS) ≥2; poor outcome, mRS ≥3). Results Finally, 203 participants (63.3±10.2 years old; BZ group, n=72; ML group, n=64; LT group, n=37; SL group, n=30) from 1190 patient cohorts were analysed. After adjusting for confounding factors, FVH (+) was associated with unfavourable outcome in total group (OR 3.02; 95% CI 1.49 to 6.13; p=0.002), BZ group (OR 4.22; 95% CI 1.25 to 14.25; p=0.021) and ML group (OR 5.44; 95% CI 1.41 to 20.92; p=0.014) patients. FVH (+) was associated with poor outcome in total group (OR 2.25; 95% CI 1.01 to 4.97; p=0.046), BZ group (OR 5.52; 95% CI 0.98 to 31.07; p=0.053) and ML group (OR 4.09; 95% CI 1.04 to 16.16; p=0.045) patients, which was marginal significance. FVH (+) was not associated with unfavourable or poor outcome in LT and SL groups. Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI. The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.
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Affiliation(s)
- Erling Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dandan Yang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jie Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China .,Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
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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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Kubota Y, Yokota H, Sakai T, Yoneyama M, Ohira K, Uno T. Clinical feasibility of single-shot fluid-attenuated inversion recovery with wide inversion recovery pulse designed to reduce cerebrospinal fluid and motion artifacts for evaluation of uncooperative patients in acute stroke protocol. J Magn Reson Imaging 2020; 53:1833-1838. [PMID: 33368729 DOI: 10.1002/jmri.27483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/06/2022] Open
Abstract
Fluid-attenuated inversion recovery (FLAIR) imaging is a key sequence for stroke assessment. Motion artifact reduction with short acquisition time is still challenging, but necessary in the magnetic resonance (MR) stroke protocol, especially for uncooperative patients suspected of stroke. The aim of this study is to investigate the feasibility of modified single-shot FLAIR with wide inversion recovery pulses for use in stroke patients. This is a prospective study, which included 30 patients clinically suspected of stroke who were examined by MR stroke protocol from January 2018 to September 2018. A 1.5 T, multi-shot-turbo spin-echo (TSE) conventional FLAIR, and single-shot-TSE-FLAIR with wide inversion recovery pulse were used. Modified single-shot FLAIR was obtained for 30 patients with suspected stroke who moved during conventional FLAIR scan. Motion artifacts were randomly and independently scored using a 5-grade scale by three radiologists in blinded fashion. Whether the FLAIR vessel hyperintensity sign was present was visually evaluated. Statistical tests included Wilcoxon-signed rank test and weighted Cohen's kappa statistics. The motion artifact score was significantly lower in single-shot FLAIR than in conventional FLAIR (0.37 ± 0.56 vs. 1.83 ± 1.18; p < 0.05. The vessel hyperintensity sign was visualized in 6 and 5 patients on single-shot and conventional FLAIR images, respectively. This study demonstrates the value of single-shot FLAIR for stroke assessment. Single-shot FLAIR reduced motion artifact and visualized vessel hyperintensity sign more than conventional FLAIR. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan
| | | | - Kenji Ohira
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Maruyama D, Yamada T, Murakami M, Fujiwara G, Komaru Y, Nagakane Y, Murakami N, Hashimoto N. FLAIR vascular hyperintensity with DWI for regional collateral flow and tissue fate in recanalized acute middle cerebral artery occlusion. Eur J Radiol 2020; 135:109490. [PMID: 33360270 DOI: 10.1016/j.ejrad.2020.109490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/05/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) extent or FVH-DWI mismatch as a primary influencing factor of clinical outcome in acute ischemic stroke is controversial. This study elucidated the regional pathophysiology and tissue fate in four types of cortical territories classified by the initial FVH and DWI findings in patients with acute proximal middle cerebral artery (M1) occlusion successfully recanalized using mechanical thrombectomy. METHODS We retrospectively evaluated 35 patients successfully recanalized within 24 h of acute M1 occlusion onset between 2016 and 2019. Each Alberta stroke program early CT score area of M1-M6 were categorized as group A (DWI-, FVH-), B (DWI-, FVH+), C (DWI+, FVH+), or D (DWI+, FVH-). Territorial collateral status was graded on a 4-point scale by initial angiogram. Follow-up head computed tomography (CT) findings on days 2-9 were assessed for the territorial outcome. RESULTS Overall, 210 cortical territories were identified; of these, 88 (41.9 %) were categorized into group A; 72 (34.3 %), group B; 37 (17.6 %), group C; and 13 (6.2 %), group D. The rate of territories with good collaterals (grade 2 or 3) significantly decreased in the order of groups as 78.3 %, 62.7 %, 27.6 %, and 0%, respectively (Ptrend <.001). Conversely, the rate of territories with any hypo- or hyper-density on follow-up CT significantly increased in the order of groups as 13.4 %, 23.1 %, 88.5 %, and 85.7 %, respectively (Ptrend <.001). CONCLUSION Categorization of cortical areas based on the FVH and DWI findings can stratify territorial collateral status and tissue fate.
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Affiliation(s)
- Daisuke Maruyama
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
| | - Takehiro Yamada
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Mamoru Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Gaku Fujiwara
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yujiro Komaru
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yoshinari Nagakane
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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27
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Factors predicting poor outcome at discharge in stroke patients with middle cerebral artery branch occlusion. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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28
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Apfaltrer P, Wenz H, Böhme J, Gawlitza M, Groden C, Alonso A, Förster A. FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis. Clin Neuroradiol 2020; 31:827-831. [PMID: 32865598 DOI: 10.1007/s00062-020-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Occlusion or significant stenosis of the internal carotid artery (ICA) in the cervical segment is commonly associated with a poststenotic decrease in the downstream blood flow and perfusion. Fluid attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are a phenomenon that represents slow arterial blood flow. In this study, we investigated the frequency and extent of FVH in the distal ICA in patients with proximal ICA stenosis. METHODS We analyzed the magnetic resonance imaging (MRI) findings in 51 patients with a total of 60 cervical ICA stenoses with special focus on the frequency and extent of FVH in the area of the petrous segment of the ICA on FLAIR images and correlated these with Doppler/duplex sonography results. RESULTS In 46 (76.7%) patients with ICA stenosis, FVH could be detected in the petrous segment of the ICA: in 19 (41.3%) patients a thin hyperintense rim near the vessel wall (grade 1), in 24 (52.2%) patients a strong hyperintense rim near the vessel wall (grade 2), and in 3 (6.5%) patients a hyperintense filling of the entire lumen (grade 3) was observed. The extent of FVH in the ICA in the petrous segment showed a high negative correlation with the poststenotic flow velocity (Spearman correlation, R = -0.75, p < 0.001), and moderate correlation with the degree of ICA stenosis (Spearman correlation, R = 0.51, p< 0.001). CONCLUSION An FVH in the petrous ICA is commonly seen among patients with steno-occlusive disease in proximal ICA and could therefore be useful to recognize a proximal ICA stenosis even on FLAIR images.
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Affiliation(s)
- Paul Apfaltrer
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Bourcier R, Thiaudière R, Legrand L, Daumas-Duport B, Desal H, Boulouis G. Accelerated MR Evaluation of Patients with Suspected Large Arterial Vessel Occlusion: Diagnostic Performances of the FLAIR Vessel Hyperintensities. Eur Neurol 2020; 83:389-394. [PMID: 32784292 DOI: 10.1159/000509077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) document slowed vascular flow at the level and after the occlusion site patients with acute ischemic stroke (AIS). We aimed to assess the accuracy of FVH for the confirmation and location of a large vessel occlusion (LVO). METHODS Three radiologists reviewed the FLAIR sequence of the admission MRI exam of patients with suspected AIS at a single academic center. Readers were provided with the main clinical deficit with National Institute of Health Stroke Severity score and were asked to identify and locate an LVO when appropriate. Kappa coefficients were calculated for agreement along with diagnosis performances of FVH to recognize and locate an LVO with digital subtracted angiography (DSA) as gold standard. RESULTS Among 125 patients screened with MRI for a suspected AIS, 96 (81%) were diagnosed with AIS and 47 (38%) patients had an anterior LVO of whom 25 (20%) had a DSA for mechanical thrombectomy. Kappa coefficients for intra- and inter-readers were good to excellent. Overall, the sensitivity and the specificity of the FVH to predict an anterior LVO was 0.98 (95% confidence interval [CI]: 0.94-1) and 0.86 (95% CI: 0.79-0.96), respectively, while PPV and NPV were 0.87 (95% CI: 0.85-0.95) and 0.98 (0.97-1), respectively. FVH also showed good to excellent accuracy for identifying M1 and M2 versus internal carotid artery occlusion site. CONCLUSION We found that FVH demonstrated excellent diagnostic performances for the identification of LVO and its level with good to excellent reproducibility. This MRI radio marker of occlusion provides additional arguments and may speed-up the detection of potential candidates for MT.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France,
| | - Romain Thiaudière
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
| | - Benjamin Daumas-Duport
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Grégoire Boulouis
- Department of Neuroradiology, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
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30
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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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Arnold SA, Platt SR, Gendron KP, West FD. Imaging Ischemic and Hemorrhagic Disease of the Brain in Dogs. Front Vet Sci 2020; 7:279. [PMID: 32528985 PMCID: PMC7266937 DOI: 10.3389/fvets.2020.00279] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023] Open
Abstract
Strokes, both ischemic and hemorrhagic, are the most common underlying cause of acute, non-progressive encephalopathy in dogs. In effect, substantial information detailing the underlying causes and predisposing factors, affected vessels, imaging features, and outcomes based on location and extent of injury is available. The features of canine strokes on both computed tomography (CT) and magnetic resonance imaging (MRI) have been described in numerous studies. This summary article serves as a compilation of these various descriptions. Drawing from the established and emerging stroke evaluation sequences used in the investigation of strokes in humans, this summary describes all theoretically available sequences. Particular detail is given to logistics of image acquisition, description of imaging findings, and each sequence's advantages and disadvantages. As the imaging features of both forms of strokes are highly representative of the underlying pathophysiologic stages in the hours to months following stroke onset, the descriptions of strokes at various stages are also discussed. It is unlikely that canine strokes can be diagnosed within the same rapid time frame as human strokes, and therefore the opportunity for thrombolytic intervention in ischemic strokes is unattainable. However, a thorough understanding of the appearance of strokes at various stages can aid the clinician when presented with a patient that has developed a stroke in the days or weeks prior to evaluation. Additionally, investigation into new imaging techniques may increase the sensitivity and specificity of stroke diagnosis, as well as provide new ways to monitor strokes over time.
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Affiliation(s)
- Susan A Arnold
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, St. Paul, MN, United States
| | - Simon R Platt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Karine P Gendron
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
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Shang WJ, Shu LM, Zhou X, Liao HQ, Chen XH, Hong H, Chen HB. Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis. Neurol Sci 2020; 41:3209-3218. [PMID: 32372196 DOI: 10.1007/s10072-020-04411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time. METHODS We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0-2 and 3-6. Symptom-to-MRI time was divided into two categories: ≤ 14 days and ≥ 15 days. RESULTS We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14 days (P = 0.008), but not in those with symptom-to-MRI times ≥15 days (P = 0.61). In the group with symptom-to-MRI times ≤14 days, patients with LA 3-6 and FVH(+) (OR, 3.044; 95% CI, 1.116-8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0-2 and FVH(+) but not compared with those with LA 0-2 and FVH(-) or LA 3-6 and FVH(-). In addition, FVH location did not influence the relationship between FVH and outcomes. CONCLUSIONS The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA.
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Affiliation(s)
- W J Shang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - L M Shu
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China.,Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, NO. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - X Zhou
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, No. 2nd Zhongshan Road, Guangzhou, 510080, China
| | - H Q Liao
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, NO. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - X H Chen
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - H Hong
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - H B Chen
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China.
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Cerebral hemodynamics associated with fluid-attenuated inversion recovery hyperintense vessels in patients with extracranial carotid artery stenosis. Neuroradiology 2020; 62:677-684. [PMID: 32152648 DOI: 10.1007/s00234-020-02385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are linked to sluggish or disordered blood flow. The purpose of this study is to compare FHVs with digital subtraction angiography (DSA) findings and cerebral hemodynamic changes on acetazolamide challenge SPECT and to determine the clinical and imaging metrics associated with FHVs in patients with extracranial carotid artery stenosis (ECAS). METHODS The subjects were patients with chronic ECAS who underwent carotid artery stenting in our department between March 2011 and October 2018. Relationships of FHVs with age, sex, medical history, cerebral angiographic findings using DSA, and quantitative values of cerebral blood flow (CBF) were examined. The resting CBF (rCBF) and cerebrovascular reactivity (CVR) in the middle cerebral artery territory were measured quantitatively using SPECT with acetazolamide challenge. We used multivariate logistic regression analysis to identify independent predictors of FHVs. RESULTS Of 173 patients included, 92 (53.2%) had FHVs. Patients with FHVs had more severe stenosis (P < 0.01) and more leptomeningeal collateral vessels (P < 0.01). FHV-positive cases had significantly reduced CVR compared with FHV-negative cases (P < 0.01), although there was no significant difference in rCBF between FHV-positive and FHV-negative cases. Logistic regression analysis showed that ipsilateral rCBF and ipsilateral CVR were significant predictors for FHVs (P < 0.01). CONCLUSION In patients with ECAS, cerebral hemodynamic metrics, especially ipsilateral rCBF and ipsilateral CVR, are associated with the presence of FHVs.
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Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack within the Anterior Circulation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7056056. [PMID: 32149125 PMCID: PMC7049427 DOI: 10.1155/2020/7056056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022]
Abstract
Purpose The aim of the present study was to evaluate the relationship of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) with haemodynamic abnormality and severity of arterial stenosis in patients with transient ischemic attack (TIA) of the carotid artery system. Patients and Methods. Consecutive inpatients (N = 38) diagnosed with TIAs of the carotid system in a 4-year period (2014–2017) were retrospectively analysed in our study and divided into FVH-negative and FVH-positive groups based on the presence of FVH sign. Each inpatient had undergone magnetic resonance imaging (MRI) followed by computed tomography (CT) perfusion imaging studies. We investigated the degree of arterial stenosis, number of stenosis, watershed regions, and related CT perfusion indexes, including hypoperfusion regions, mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). Spearman rank correlation was performed between FVHs score, the degree of arterial stenosis, and CT perfusion indexes with significant difference. Results Thirty-one patients (81.6%) observed with FVH sign were assigned to the FVH-positive group. The hypoperfusion regions, MTT, and CBF values were significantly different between the FVH-negative group and FVH-positive groups. Spearman correlation analysis showed significant positive correlations between hypoperfusion regions, MTT, and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores (r = 0.755 and 0.674, respectively, p < 0.01); a moderate negative correlation was found between CBF and FVHs scores ( Conclusion Hyperintense vessels on FLAIR were closely associated with hypoperfused regions, MTT, and CBF values, which indicated that the presence of FVHs could be an important and convenient imaging marker of haemodynamic impairment in patients with TIA.
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Wang Y, Zhou Z, Ding S. FLAIR vascular hyperintensity-DWI mismatch most likely to benefit from recanalization and good outcome after stroke. Medicine (Baltimore) 2020; 99:e18665. [PMID: 31914055 PMCID: PMC6959955 DOI: 10.1097/md.0000000000018665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/17/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ± 1.53 vs 3.49 ± 1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.
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Heo SA, Kim ES, Lee Y. Reversible Cerebral Vasoconstriction Syndrome Presenting as Transient Vessel Wall Enhancement on Contrast-Enhanced Fluid-Attenuated Inversion Recovery Images: A Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1239-1245. [PMID: 36238038 PMCID: PMC9431866 DOI: 10.3348/jksr.2019.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 11/15/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical and radiological syndrome with primary features that include hyperacute onset of severe headache and segmental vasoconstriction of the cerebral arteries, which resolve within 3 months. Vessel wall enhancement has been reported in some cases of RCVS; however, its pathophysiological and diagnostic implications remain unclear. We review a case of RCVS in a patient with transient vessel wall enhancement on contrast-enhanced fluid-attenuated inversion recovery images, focusing on the pathophysiological and diagnostic implications.
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Affiliation(s)
- Sun Ah Heo
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yul Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Aoki J, Suzuki K, Suda S, Okubo S, Mishina M, Kimura K. Negative-FLAIR vascular hyperintensities serve as a marker of no recanalization during hospitalization in acute stroke. J Clin Neurosci 2019; 72:233-237. [PMID: 31836384 DOI: 10.1016/j.jocn.2019.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since acute fluid-attenuated inversion recovery vascular hyperintensity (FVH) is indicative of disordered blood flow, FVH is considered a marker of acute major arterial occlusion. Conversely, the role of the absence of FVH (negative-FVH) remains unknown. METHODS Consecutive stroke patients were studied via magnetic resonance angiography, within 24 h of onset and major arterial occlusion. All patients were examined using serial angiography to evaluate the presence of recanalization. Patients were classified into negative-FVH and positive-FVH groups. RESULTS A total of 72 patients (49 [68%] male patients, aged 76 [66-83] years) were enrolled. Ten patients were allocated to the negative-FVH group and 62 to the positive-FVH group. Initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (2-8) in the negative-FVH group and 10 (4-21) in the positive-FVH group (p = 0.012). Recanalization was achieved in 1 (10%) of the 10 patients in the negative-FVH group and in 49 (79%) of the 62 patients in the positive-FVH group during hospitalization (p < 0.001). Patients with recanalization were older (p = 0.023), had higher NIHSS score (p = 0.008), were admitted earlier (p = 0.014), exhibited a higher prevalence of atrial fibrillation (p = 0.010) and anterior circulation occlusion (p = 0.021), and were more frequently treated with hyperacute recanalization therapy (p = 0.004). Multivariate regression analysis demonstrated that negative-FVH (odds ratio 0.087, 95% confidential interval [0.008-0.988], p = 0.049) was a negative independent factor associated with recanalization during hospitalization. CONCLUSIONS In conclusion, negative-FVH in acute stroke was associated with lack of recanalization during hospitalization.
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Affiliation(s)
- Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Kentaro Suzuki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Seiji Okubo
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Mishina
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Xu Z, Duan Y, Yang B, Huang X, Pei Y, Li X. Asymmetric Deep Medullary Veins in Patients With Occlusion of a Large Cerebral Artery: Association With Cortical Veins, Leptomeningeal Collaterals, and Prognosis. Front Neurol 2019; 10:1292. [PMID: 31866937 PMCID: PMC6906174 DOI: 10.3389/fneur.2019.01292] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022] Open
Abstract
Objective: To explore the relationships of asymmetric deep medullary veins (ADMV) to asymmetric cortical veins (ACV), leptomeningeal collaterals and prognosis in patients with occlusion of a large cerebral artery. Methods: Clinical and imaging data of 56 patients with occlusion of a large cerebral artery were collected and reviewed. We assessed the time delayed between stroke onset and MR imaging (within 24 h of stroke onset), extension of cerebral infarction using the Alberta stroke program early CT score based on diffusion-weighted imaging (ASPECTs). ADMV and ACV were assessed using susceptibility-weighted imaging. The presence of ADMV (ACV) was defined as deep medullary veins (cortical veins) of the affected hemisphere that were greater in number and diameter than in the contralateral hemisphere. To evaluate leptomeningeal collaterals, the hyperintense vessel sign (HVS) was detected using T2 weighted fluid attenuated inversion recovery images. At 90 days, a modified Rankin scale score (mRS) was assessed to evaluate the clinical outcome. Results: Of 56 patients, 27 presented with ADMV. Those patients who presented with and without ADMV differed significantly in HVS and ACV (P < 0.05) but not in time delayed between stroke onset and MR imaging, age, gender, stroke risk factors, baseline NIHSS score, or modified Rankin scale score at 3 months (P > 0.05). Logistic regression analysis found that the presence of ADMV was independently related to HVS and ACV (ACV: OR 95% C.I., 1.287-4.368; HVS: OR 95% C.I., 1.132-4.887). Conclusions: The presence of ADMV on SWI was associated with prominent ACV and good leptomeningeal collateral flow but was not related to prognosis in patients with occlusion of a large cerebral artery.
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Affiliation(s)
- Zhihua Xu
- Department of Radiology, TongDe Hospital of Zhejiang Province, Hangzhou, China.,Department of Radiology, Center for Neuroimaging, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Duan
- Department of Radiology, Center for Neuroimaging, The General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xin Huang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yusong Pei
- Department of Radiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoqiu Li
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, China
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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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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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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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Kim DH, Lee YK, Cha JK. Prominent FLAIR Vascular Hyperintensity Is a Predictor of Unfavorable Outcomes in Non-thrombolysed Ischemic Stroke Patients With Mild Symptoms and Large Artery Occlusion. Front Neurol 2019; 10:722. [PMID: 31312181 PMCID: PMC6614286 DOI: 10.3389/fneur.2019.00722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background and objective: The aim was to evaluate the clinical significance of prominent fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) on the prognosis of mild acute ischemic stroke with middle cerebral artery (MCA) occlusion. Methods: We recruited consecutive stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 and MCA occlusion on magnetic resonance angiography within 24 h of stroke onset. Prominent distal FVH was defined as an extension to more than one-third of the MCA territory. We compared clinical outcomes between prominent and non-prominent FVH groups in patients who had and had not received reperfusion therapy. Results: Of 112 participants [43 women; median age, 67 years [Interquartile range, 54–79]], prominent FVH was identified in 80 (71.4%). For 75 patients who had not received reperfusion therapy, the prominent FVH group had a more unfavorable outcome (modified Rankin Scale score >1) at 3 months than the non-prominent FVH group (44.4 vs. 15.0%, P = 0.029). In multivariate analysis, a higher NIHSS score [odd ratio [OR] = 1.67; 95% confidence interval [CI], 1.16–2.41; P = 0.006], proximal MCA occlusion [OR = 7.31; 95% CI, 1.68–31.9; P = 0.008], and prominent FVH [OR = 5.49; 95% CI, 1.29–23.4; P = 0.021], were independently associated with an unfavorable outcome. There was no association between prominent FVH and the clinical outcome in the reperfusion therapy group. Conclusions: For acute stroke patients with mild symptoms and MCA occlusion who do not receive reperfusion therapy, prominent FVH and proximal MCA occlusion may be independent predictors of an unfavorable outcome.
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Affiliation(s)
- Dae-Hyun Kim
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, South Korea.,Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
| | - Yoon-Kyung Lee
- Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
| | - Jae-Kwan Cha
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, South Korea.,Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
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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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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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Jiang L, Chen YC, Zhang H, Peng M, Chen H, Geng W, Xu Q, Yin X, Ma Y. FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome. Eur Radiol 2019; 29:4879-4888. [PMID: 30762112 DOI: 10.1007/s00330-019-06022-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 01/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently found in stroke patients after intracranial arterial occlusion, but the prognostic value of FVH findings is unclear. We assessed whether FVH is associated with cerebral collateral status and functional outcome in patients with acute stroke patients receiving endovascular therapy. METHODS FVH score, American Society of Interventional and Therapeutic Neuroradiology (ASITN) grade, the functional outcome at 3 months (modified Rankin Scale (mRS)), and other clinical data were collected for 37 acute stroke patients with large vessel occlusion (LVO) receiving MRI before and after endovascular therapy. Statistical analysis was performed to predict functional outcome after stroke. RESULTS The good functional outcome group (n = 16) had a higher FVH1 (FVH before therapy) score (4.63 ± 1.20 vs 3.14 ± 1.15; p = 0.001) and ASITN grade (3.31 ± 0.48 vs 2.00 ± 1.22; p < 0.001) and a lower FVH2 (FVH after therapy) score than the poor functional outcome group (n = 21; 0.125 ± 0.50 vs 1.44 ± 2.16; p = 0.030). mRS at 3 months was negatively correlated with FVH1 (r = - 0.525, p = 0.001) and the ASITN grade (r = - 0.478, p = 0.003) and positively correlated with FVH2 (r = 0.376, p = 0.034). FVH1 (OR, 0.085; 95% CI, 0.013-0.577; p = 0.012) and FVH2 (OR, 2.724; 95% CI, 1.061-6.996; p = 0.037) were independently associated with functional outcome in multivariable logistic regression analysis. CONCLUSIONS Assessing FVH before and after therapy in acute stroke patients with LVO might be useful for predicting functional outcome after stroke. KEY POINTS • Fluid-attenuated inversion recovery vascular hyperintensity is a circular or serpentine brightening in the brain parenchyma or cortical surface bordering the subarachnoid space on MR imaging. • A prospective study showed that fluid-attenuated inversion recovery vascular hyperintensity is associated with cerebral collateral circulation and prognosis. • Fluid-attenuated inversion recovery vascular hyperintensity helps clinicians to predict the prognosis of patients with acute stroke.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Mingyang Peng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Quan Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
| | - Yuehu Ma
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
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Nave AH, Kufner A, Bücke P, Siebert E, Kliesch S, Grittner U, Bäzner H, Liebig T, Endres M, Fiebach JB, Nolte CH, Ebinger M, Henkes H. Hyperintense Vessels, Collateralization, and Functional Outcome in Patients With Stroke Receiving Endovascular Treatment. Stroke 2018; 49:675-681. [DOI: 10.1161/strokeaha.117.019588] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Fluid-attenuated inversion recovery hyperintense vessels (FHV) are frequently observed on magnetic resonance imaging in acute stroke patients with proximal vessel occlusion. Whether FHV can serve as a surrogate for the collateral status and predict functional outcome of patients is still a matter of debate.
Methods—
Acute ischemic stroke patients with M1-middle cerebral artery occlusion who received magnetic resonance imaging before endovascular treatment in 3 hospitals in Germany between January 2007 and June 2016 were eligible. Quantification of FHV was performed using an FHV–Alberta Stroke Program Early CT Score (ASPECTS) rating system. Functional outcome was evaluated with the modified Rankin Scale 3 months after stroke. Collateral status of patients was graded on baseline angiography using the American Society of Interventional and Therapeutic Neuroradiology grading system. Odds for good outcome (modified Rankin Scale score, 0–2) were determined using logistic regression analyses.
Results—
Overall, 116 patients were analyzed (median age, 74; interquartile range [IQR], 64–79; median National Institutes of Health Stroke Scale, 14; IQR, 10–19). The median FHV-ASPECTS was 2 (IQR, 1–3). Good collateral status (American Society of Interventional and Therapeutic Neuroradiology grade 3–4) on angiography was more frequently observed in patients with FHV-ASPECTS ≤2 (83% versus 57%;
P
=0.025). Patients with an FHV-ASPECTS ≤2 had a better functional outcome after 3 months (median modified Rankin Scale score, 2; IQR, 0–5), compared with patients with an FHV-ASPECTS >2 (median modified Rankin Scale score, 4; IQR, 3–6;
P
=0.015). In multiple regression analyses, FHV-ASPECTS ≤2 was independently associated with good functional outcome (adjusted odds ratio, 5.3; 95% confidence interval, 1.5–18.2).
Conclusions—
Low FHV-ASPECTS is associated with both better collateral status and better 3-month functional outcome in acute stroke patients with M1 vessel occlusion.
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Affiliation(s)
- Alexander H. Nave
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Anna Kufner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Philipp Bücke
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Eberhard Siebert
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Stefan Kliesch
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Ulrike Grittner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Hansjörg Bäzner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Thomas Liebig
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Matthias Endres
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Jochen B. Fiebach
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Christian H. Nolte
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Martin Ebinger
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Hans Henkes
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
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Nam KW, Kim CK, Kim TJ, Oh K, Han MK, Ko SB, Yoon BW. FLAIR vascular hyperintensities predict early ischemic recurrence in TIA. Neurology 2018; 90:e738-e744. [DOI: 10.1212/wnl.0000000000005034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/30/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and early ischemic lesion recurrence (follow-up diffusion-weighted imaging [FU-DWI] [+]) in patients with lesion-negative TIA.MethodsWe recruited consecutive patients with lesion-negative TIA within 24 hours of symptom onset, who underwent follow-up MRI during the acute period. FVH was defined as a focal or serpentine high signal intensity on FLAIR images. Other potential confounders were adjusted to evaluate the relationship between FVH and FU-DWI (+). Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (−) groups, we assessed 1-year recurrent ischemic stroke or TIA.ResultsAmong 392 patients with lesion-negative TIA, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) (adjusted odds ratio [aOR] = 4.77, 95% confidence interval [CI] 2.45–9.29, p < 0.001). The time to initial MRI (aOR = 0.49, 95% CI = 0.33–0.70, p < 0.001) and intracranial atherosclerosis (aOR = 2.07, 95% CI = 1.10–3.92, p = 0.025) were also associated with FU-DWI (+), independent of FVH. In clinical outcomes, the FU-DWI (+) group showed more frequent 1-year recurrent ischemic stroke events than the FU-DWI (−) group (10.7% vs 3.1%, respectively, p = 0.007).ConclusionsFVH is associated with FU-DWI (+) in patients with lesion-negative TIA. As FU-DWI (+) frequently occurs during the acute period and has a subsequent worse outcome after discharge, additional radiologic or clinical markers for it are necessary.
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Abstract
PURPOSE OF REVIEW This article provides an overview of cerebrovascular hemodynamics, acute stroke pathophysiology, and collateral circulation, which are pivotal in the modern imaging of ischemic stroke that guides the care of the patient with stroke. RECENT FINDINGS Neuroimaging provides extensive information on the brain and vascular health. Multimodal CT and MRI delineate the hemodynamics of ischemic stroke that may be used to guide treatment decisions and prognosticate regarding expected outcomes. Mismatch imaging with either CT or MRI may identify patients with salvageable regions who are at risk and likely to benefit from reperfusion therapy, even if they are outside the standard time window. Imaging of collateral circulation and determination of collateral grade may predict greater reperfusion, lower hemorrhage risk, and better functional outcome. Current neuroimaging technology also enables the identification of patients at high risk of hemorrhagic transformation or those who may be harmed by treatment or unlikely to benefit from it. SUMMARY This article reviews the use and impact of imaging for the patient with ischemic stroke, emphasizing how imaging builds upon clinical evaluation to establish diagnosis or etiology, reveal key pathophysiology, and guide therapeutic decisions.
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