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Articles
February 11, 2009

Distal hyperintense vessels on FLAIR
An MRI marker for collateral circulation in acute stroke?

March 31, 2009 issue
72 (13) 1134-1139

Abstract

Background: Hyperintense vessels (HV) on fluid-attenuated inversion recovery imaging are frequently observed in acute ischemic stroke patients. However, the exact mechanism and clinical implications of this sign have not yet been clearly defined. The features of HV and its relevance to other imaging factors are presented here.
Methods: Prominence and location of HV were documented in 52 consecutive patients with middle cerebral artery (MCA) territory infarction, before treatment with IV recombinant tissue plasminogen activator. Pretreatment ischemic lesion volume, perfusion lesion volume, and vessel occlusion were determined in addition to recanalization status and ischemic lesion volume on follow-up imaging. NIH Stroke Scale (NIHSS) was used as a measure of clinical severity.
Results: HV distal to arterial occlusion was observed in 73% of patients; more frequent in proximal than distal MCA occlusion patients. Among the 38 patients with proximal MCA occlusion, initial perfusion lesion volume was comparable among patients with different grade distal HV. However, patients with more prominent distal HV had smaller initial, 24-hour, and subacute ischemic lesion volumes and lower initial NIHSS scores.
Conclusions: The presence of distal hyperintense vessels before thrombolytic treatment is associated with large diffusion–perfusion mismatch and smaller subacute ischemic lesion volumes in patients with proximal middle cerebral artery occlusion.
DWI = diffusion-weighted imaging; FLAIR = fluid-attenuated inversion recovery; GRE = gradient recalled echo; HV = hyperintense vessels; MCA = middle cerebral artery; MRA = magnetic resonance angiography; MTT = mean transit time; NIHSS = NIH Stroke Scale; PWI = perfusion-weighted imaging; rt-PA = recombinant tissue plasminogen activator; TE = echo time; TI = inversion time; TIMI = thrombolysis in myocardial infarction; TR = repetition time.

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Information & Authors

Information

Published In

Neurology®
Volume 72Number 13March 31, 2009
Pages: 1134-1139
PubMed: 19211928

Publication History

Published online: February 11, 2009
Published in print: March 31, 2009

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Authors

Affiliations & Disclosures

K. Y. Lee, MD, PhD
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.
L. L. Latour, PhD
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.
M. Luby, PhD
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.
A. W. Hsia, MD
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.
J. G. Merino, MD, MPhil
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.
S. Warach, MD, PhD
From the Section on Stroke Diagnostics and Therapeutics (K.Y.L., L.L.L., M.L., J.G.M., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; the Washington Hospital Center Stroke Center (A.W.H.), Washington, DC; and the Department of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Korea.

Notes

Address correspondence and reprint requests to Dr. Steven Warach, Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892-1063 [email protected]

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  2. Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI, Journal of Clinical Medicine, 12, 4, (1554), (2023).https://doi.org/10.3390/jcm12041554
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  3. Prognostic factors for acute large vessel occlusion with NIHSS 5 or lower, The Journal of Medical Investigation, 70, 1.2, (22-27), (2023).https://doi.org/10.2152/jmi.70.22
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  5. Individualized interpretation for the clinical significance of fluid-attenuated inversion recovery vessel hyperintensity in ischemic stroke and transient ischemic attack: A systematic narrative review, European Journal of Radiology, 166, (111010), (2023).https://doi.org/10.1016/j.ejrad.2023.111010
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  7. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy, Diagnostic and Interventional Imaging, 104, 7-8, (337-342), (2023).https://doi.org/10.1016/j.diii.2023.02.005
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  8. Stroke in a young adult: looking beyond the diffusion-weighted imaging sequence, Neurological Sciences, (2023).https://doi.org/10.1007/s10072-023-07237-2
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